Provider Demographics
NPI:1104296318
Name:RLGDIGNIFIEDLIVINGOFPLANO
Entity type:Organization
Organization Name:RLGDIGNIFIEDLIVINGOFPLANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOKONYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-786-1573
Mailing Address - Street 1:2816 TALLAHASSEE CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-2040
Mailing Address - Country:US
Mailing Address - Phone:469-786-1573
Mailing Address - Fax:
Practice Address - Street 1:2816 TALLAHASSEE CT
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-2040
Practice Address - Country:US
Practice Address - Phone:469-786-1573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8901Medicaid
TX8901Medicaid
TX890300000000015Medicare Oscar/Certification
TX8902000000Medicare NSC
TX8904Medicare PIN