MEDICARE: APPLEGATE HEALTH 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1982370011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLEGATE HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	1720 LAKEPOINTE DR STE 117
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-6425
Country	:	US
Telephone Number	:	214-379-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	6017 STONEY CREEK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-4410
Country	:	US
Telephone Number	:	260-267-5157
Fax Number	:

Authorized Official
Title or Position	:	VP, TREASURER
Name	:	BRUCE JARVIE
Credential	:
Telephone Number	:	214-379-3300

Provider Enumeration Date	:	08/18/2021
Last Update Date	:	07/29/2024

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