MEDICARE: ANDA CARE LLC

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	177F00000X	Lodging Provider
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1083461974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDA CARE LLC

Provider Business Mailing Address
First Line	:	1656 CHUCHILL LANE
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7906
Country	:	US
Telephone Number	:	917-916-2842
Fax Number	:

Provider Business Practice Location Address
First Line	:	7224 MARTHA LANE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-5347
Country	:	US
Telephone Number	:	817-851-1876
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CELESTIN NGNABEUYE
Credential	:
Telephone Number	:	917-916-2842

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	05/07/2026

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Directions to “ANDA CARE LLC ” Practice Location

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