Provider Demographics
NPI:1104526680
Name:RICHARDSON SERVICES LLC
Entity type:Organization
Organization Name:RICHARDSON SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MINESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-210-5093
Mailing Address - Street 1:3419 WESTMINSTER AVE # 1013
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1387
Mailing Address - Country:US
Mailing Address - Phone:972-210-5093
Mailing Address - Fax:
Practice Address - Street 1:3419 WESTMINSTER AVE # 1013
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1387
Practice Address - Country:US
Practice Address - Phone:972-210-5093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35857158OtherPRAVITE PAY
TX35857158Medicaid