Organization
HOUSE OF MARY LOU HOME CARE SOLUTIONS LLC
Active
Other names
House of Mary Lou
Organization subpart
No
Provider details
NPI number
Authorized official
KEONTAQUE ABRON (DIRECTOR PERSONAL CARE COORDINATOR)
(214) 264-1201
Entity
Organization
Contact information
Practice address
1522 WAWEENOC AVE, DALLAS, TX 75216-6312
(214) 264-1201
Mailing address
1010 MYSTIC TRL, CEDAR HILL, TX 75104-3188
(214) 264-1201
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251F00000X
Home Infusion Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
251T00000X
PACE Provider Organization
—
—
251V00000X
Voluntary or Charitable Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
N/A I DO NOT HAVE ONE
—
Enumeration date
06/13/2019
Last updated
06/13/2019
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