Provider Demographics
NPI:1538531348
Name:GIFT OF LIFE COMMUNITY HOME
Entity type:Organization
Organization Name:GIFT OF LIFE COMMUNITY HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:VASHUND
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND, CHHC
Authorized Official - Phone:817-691-7238
Mailing Address - Street 1:3220 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2990
Mailing Address - Country:US
Mailing Address - Phone:817-691-7238
Mailing Address - Fax:888-959-2093
Practice Address - Street 1:6510 VIRGINIA PKWY
Practice Address - Street 2:108
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5510
Practice Address - Country:US
Practice Address - Phone:817-691-7238
Practice Address - Fax:888-959-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X, 320700000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities