MEDICARE: AMPLE HEALTH SERVICES

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	251S00000X	Community/Behavioral Health Agency	70461	TX

General Provider Information

NPI Number	:	1285058768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMPLE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2528 NORTH FITZHUGH AVENUE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-3387
Country	:	US
Telephone Number	:	972-253-0000
Fax Number	:	214-823-2550

Provider Business Practice Location Address
First Line	:	2528 N FITZHUGH AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-3387
Country	:	US
Telephone Number	:	972-253-0000
Fax Number	:	214-823-2550

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	EDDIE CHIEDOZIE OSUAGWU
Credential	:	LPCI/LCDC, M.ED, M.S
Telephone Number	:	972-253-0000

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	02/05/2014

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Directions to “AMPLE HEALTH SERVICES ” Practice Location

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