Provider Demographics
NPI:1679109854
Name:DALLAS TRANSITION SERVICES LLC
Entity Type:Organization
Organization Name:DALLAS TRANSITION SERVICES LLC
Other - Org Name:DALLAS ELITE TAS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHOSHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-207-9117
Mailing Address - Street 1:1029 JOHNSON CITY AVE
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5077
Mailing Address - Country:US
Mailing Address - Phone:214-207-9117
Mailing Address - Fax:972-552-5232
Practice Address - Street 1:1029 JOHNSON CITY AVE
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-5077
Practice Address - Country:US
Practice Address - Phone:214-207-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF500310760Medicaid
TXNAMedicaid