Provider Demographics
NPI:1689785289
Name:TREASURE LIFE HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:TREASURE LIFE HEALTHCARE SERVICES, INC.
Other - Org Name:TREASURE LIFE HEALTHCARE SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:V
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-484-6084
Mailing Address - Street 1:8111 LBJ FWY STE 1330A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1313
Mailing Address - Country:US
Mailing Address - Phone:214-484-6084
Mailing Address - Fax:214-484-6554
Practice Address - Street 1:8111 LBJ FWY STE 1330A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1313
Practice Address - Country:US
Practice Address - Phone:214-484-6084
Practice Address - Fax:214-484-6554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009299251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC457905Medicare ID - Type Unspecified