MEDICARE: NEXPHASE HEALTHCARE 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	85-2892674	OTHER	TX	IRS

General Provider Information

NPI Number	:	1497369474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXPHASE HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1201 N WATSON RD STE 205
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6120
Country	:	US
Telephone Number	:	817-500-7577
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 N WATSON RD STE 205
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6120
Country	:	US
Telephone Number	:	817-500-7577
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LOVELINE NCHE
Credential	:
Telephone Number	:	817-500-7577

Provider Enumeration Date	:	09/07/2020
Last Update Date	:	09/08/2020

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Directions to “NEXPHASE HEALTHCARE LLC ” Practice Location

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