Healthcare Provider Details

I. General information

NPI: 1710784558
Provider Name (Legal Business Name): THE KINDRED ADVANTAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 05/21/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 BREEZEWAY CT
CEDAR HILL TX
75104-6734
US

IV. Provider business mailing address

3424 S COCKRELL HILL RD
DALLAS TX
75236-1112
US

V. Phone/Fax

Practice location:
  • Phone: 972-504-4074
  • Fax: 469-575-4522
Mailing address:
  • Phone: 972-998-6901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNN M CLARK
Title or Position: EXECUTIVE DIRECTOR
Credential: RPH
Phone: 972-998-6901