Provider Demographics
NPI:1023511029
Name:MY SAINTS
Entity type:Organization
Organization Name:MY SAINTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:SHAEDERRICA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-762-1281
Mailing Address - Street 1:5311 WENDEL DR
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-4813
Mailing Address - Country:US
Mailing Address - Phone:318-762-1281
Mailing Address - Fax:
Practice Address - Street 1:8640 COVE MEADOW LN
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2330
Practice Address - Country:US
Practice Address - Phone:318-762-1281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY SAINTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX081112616251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081112616OtherDBA