MEDICARE: CITADEL HAELTHCARE SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	009243	TX

General Provider Information

NPI Number	:	1043368673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITADEL HAELTHCARE SERVICES INC

Provider Business Mailing Address
First Line	:	12959 JUPITER RD
Second Line	:	SUITE 202
City	:	DALLAS
State	:	TX
Zip	:	75238-5223
Country	:	US
Telephone Number	:	214-349-5900
Fax Number	:	214-349-5944

Provider Business Practice Location Address
First Line	:	12959 JUPITER RD
Second Line	:	SUITE 202
City	:	DALLAS
State	:	TX
Zip	:	75238-5223
Country	:	US
Telephone Number	:	214-349-5900
Fax Number	:	214-349-5944

Authorized Official
Title or Position	:	ADMINISTRATOR, DIRECTOR OF NURSING
Name	:	MS. UDUAK E INYANG
Credential	:	RN
Telephone Number	:	214-349-5900

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/22/2020

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