| Organization Name: | ABC PROVIDER DFW LLC |
| NPI Number: | 1124429675 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES MICHAEL FORBES (OWNER / ADMINISTRATOR) |
| Mailing Address: | 751 Hebron Pkwy Suite 210 Lewisville |
| State: | TX US |
| Postal Code: | 750575055 |
| Phone Number: | 2144691440 |
| Fax Number: | 2144691441 |
| NPI Enumeration Date: | 09/15/2014 |
| NPI Last Update Date: | 09/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | 015102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |