Healthcare Provider Details

I. General information

NPI: 1598257578
Provider Name (Legal Business Name): HENOSIS MANAGMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 WALLACE LN
CHARLOTTE NC
28212-6427
US

IV. Provider business mailing address

777 MAIN ST STE 600 C/O PFS TEXAS HOLDINGS, LLC
FORT WORTH TX
76102-5368
US

V. Phone/Fax

Practice location:
  • Phone: 817-529-0544
  • Fax: 817-612-6677
Mailing address:
  • Phone: 817-529-0544
  • Fax: 817-612-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YUSEFF HOWARD
Title or Position: MANAGING PARTNER
Credential:
Phone: 817-529-0544