Provider Demographics
NPI:1871980169
Name:MY HOME DFW MSO LLC
Entity type:Organization
Organization Name:MY HOME DFW MSO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:A
Authorized Official - Last Name:TIPPING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-472-0161
Mailing Address - Street 1:630 N HIGHWAY 67 STE 2
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2156
Mailing Address - Country:US
Mailing Address - Phone:214-339-2221
Mailing Address - Fax:214-432-1117
Practice Address - Street 1:630 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2156
Practice Address - Country:US
Practice Address - Phone:214-339-2221
Practice Address - Fax:214-432-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management