Provider Demographics
NPI:1265908453
Name:GRIFFIN, DARRENCE E SR
Entity type:Individual
Prefix:
First Name:DARRENCE
Middle Name:E
Last Name:GRIFFIN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 WHISPERING CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-2035
Mailing Address - Country:US
Mailing Address - Phone:214-372-6831
Mailing Address - Fax:214-372-1743
Practice Address - Street 1:1208 WHISPERING CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-2035
Practice Address - Country:US
Practice Address - Phone:214-372-6831
Practice Address - Fax:214-372-1743
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2023-11-16
Deactivation Date:2019-04-17
Deactivation Code:
Reactivation Date:2019-07-31
Provider Licenses
StateLicense IDTaxonomies
TX146693310400000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility