Organization
NIMROD NATION ENTERPRISE LLC
Active
Other names
Hero's Haven
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RASBY G MASON III (OWNER)
(318) 230-8410
Entity
Organization
Contact information
Practice address
1700 W POLO RD STE 128, GRAND PRAIRIE, TX 75052-1821
(318) 230-8414
(318) 626-7179
Mailing address
1700 W POLO RD STE 128, GRAND PRAIRIE, TX 75052-1821
(318) 626-7179
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251300000X
Local Education Agency (LEA)
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251T00000X
PACE Provider Organization
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QV0200X
VA Clinic/Center
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
08/26/2022
Last updated
08/26/2022
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