Provider Demographics
NPI:1528460615
Name:SERVANT LIFE SERVICES
Entity type:Organization
Organization Name:SERVANT LIFE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:214-729-4899
Mailing Address - Street 1:9838 BROKEN BOW RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2634
Mailing Address - Country:US
Mailing Address - Phone:214-729-4899
Mailing Address - Fax:
Practice Address - Street 1:9838 BROKEN BOW RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2634
Practice Address - Country:US
Practice Address - Phone:214-729-4899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health