Proline 121 LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROLINE 121 LLC

Practice address

3702 Dandridge Cir
Garland, TX 75040-3506

Phone

(469) 337-7622

NPI assigned

Jun 11, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Peecee Charuma

Title

Administrator

Phone

(469) 337-7622

Specialties & licenses 3

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1164047478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 DANDRIDGE CIR",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750403506",
            "telephone_number": "469-337-7622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 DANDRIDGE CIR",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750403506",
            "telephone_number": "469-337-7622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLINE 121 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-11",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "CHARUMA",
        "authorized_official_first_name": "PEECEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "469-337-7622"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "none",
            "affiliation": "N",
            "endpointDescription": "none",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "none",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3702 Dandridge Cir",
            "city": "Garland",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750403506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.