Provider Demographics
NPI:1609259308
Name:SIMPLE RESIDENTIAL CARE LTD. CO
Entity Type:Organization
Organization Name:SIMPLE RESIDENTIAL CARE LTD. CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHIDAA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-808-5630
Mailing Address - Street 1:109 SPRINGRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-8031
Mailing Address - Country:US
Mailing Address - Phone:817-808-5630
Mailing Address - Fax:877-335-9334
Practice Address - Street 1:109 SPRINGRIDGE LN
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-8031
Practice Address - Country:US
Practice Address - Phone:817-808-5630
Practice Address - Fax:877-335-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home