Provider Demographics
NPI:1952666539
Name:VAN DYCK HOME CARE ENTERPRISES, LLC
Entity Type:Organization
Organization Name:VAN DYCK HOME CARE ENTERPRISES, LLC
Other - Org Name:LIFRESPRING HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN DYCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-249-6800
Mailing Address - Street 1:4647 YUCCA FLATS TRL
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-8333
Mailing Address - Country:US
Mailing Address - Phone:361-815-4446
Mailing Address - Fax:817-249-6802
Practice Address - Street 1:9608 BARTLETT CIR STE 150
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4449
Practice Address - Country:US
Practice Address - Phone:817-249-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015436251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679009Medicare UPIN
TX679009Medicare PIN