Provider Demographics
NPI:1962756502
Name:COMPANION RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:COMPANION RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILIANA
Authorized Official - Middle Name:NTWINA
Authorized Official - Last Name:MANDARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-868-5151
Mailing Address - Street 1:237 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-4621
Mailing Address - Country:US
Mailing Address - Phone:214-868-5151
Mailing Address - Fax:214-275-7663
Practice Address - Street 1:1001 BUSINESS PKWY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5024
Practice Address - Country:US
Practice Address - Phone:214-868-5151
Practice Address - Fax:214-275-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care