Healthcare Provider Details

I. General information

NPI: 1619276466
Provider Name (Legal Business Name): GAVI HEALTHCARE MANAGEMENT GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 VICTORY CREST DR # C
ARLINGTON TX
76002-3672
US

IV. Provider business mailing address

6701 VICTORY CREST DR # C
ARLINGTON TX
76002-3672
US

V. Phone/Fax

Practice location:
  • Phone: 817-226-8759
  • Fax: 817-466-8756
Mailing address:
  • Phone: 817-226-8759
  • Fax: 817-466-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number00966
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number00966
License Number StateTX

VIII. Authorized Official

Name: MR. FRANCIS DEKU
Title or Position: PRESIDENT
Credential:
Phone: 817-226-8759