Provider Demographics
NPI:1184234502
Name:HOME OF ELEGANCE
Entity type:Organization
Organization Name:HOME OF ELEGANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-204-8290
Mailing Address - Street 1:2901 THORSON LN APT 1207
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-2077
Mailing Address - Country:US
Mailing Address - Phone:817-204-8290
Mailing Address - Fax:
Practice Address - Street 1:2901 THORSON LN APT 1207
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-2077
Practice Address - Country:US
Practice Address - Phone:817-204-8290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty