Provider Demographics
NPI:1801946389
Name:SUMAINA IBRAHIM
Entity type:Organization
Organization Name:SUMAINA IBRAHIM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUMAINA
Authorized Official - Middle Name:SANU
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:BBA, MPA
Authorized Official - Phone:817-714-2262
Mailing Address - Street 1:2610 W MARSHALL DR STE 4
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3540
Mailing Address - Country:US
Mailing Address - Phone:972-206-7772
Mailing Address - Fax:972-206-7774
Practice Address - Street 1:2610 W MARSHALL DR STE 4
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3540
Practice Address - Country:US
Practice Address - Phone:972-206-7772
Practice Address - Fax:972-206-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicare ID - Type Unspecified