Provider Demographics
NPI:1972720084
Name:PT HOME SERVICES OF DALLAS, INC.
Entity Type:Organization
Organization Name:PT HOME SERVICES OF DALLAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORIGAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-468-4747
Mailing Address - Street 1:22215 NORTHERN BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3603
Mailing Address - Country:US
Mailing Address - Phone:718-468-4747
Mailing Address - Fax:718-264-5834
Practice Address - Street 1:8200 BROOKRIVER DR
Practice Address - Street 2:# N503
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4069
Practice Address - Country:US
Practice Address - Phone:214-678-0507
Practice Address - Fax:214-678-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX066014403Medicaid