Provider Demographics
NPI:1023678943
Name:HOUSE OF MARY LOU HOME CARE SOLUTIONS LLC
Entity type:Organization
Organization Name:HOUSE OF MARY LOU HOME CARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PERSONAL CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEONTAQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-264-1201
Mailing Address - Street 1:1010 MYSTIC TRL
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3188
Mailing Address - Country:US
Mailing Address - Phone:214-264-1201
Mailing Address - Fax:
Practice Address - Street 1:1522 WAWEENOC AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-6312
Practice Address - Country:US
Practice Address - Phone:214-264-1201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251F00000XAgenciesHome Infusion
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No251V00000XAgenciesVoluntary or Charitable
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A I DO NOT HAVE ONE