Healthcare Provider Details

I. General information

NPI: 1598902363
Provider Name (Legal Business Name): ST. MICHAEL'S HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7324 SKILLMAN ST APT 1502
DALLAS TX
75231-4978
US

IV. Provider business mailing address

7324 SKILLMAN ST APT 1502
DALLAS TX
75231-4978
US

V. Phone/Fax

Practice location:
  • Phone: 315-601-3152
  • Fax:
Mailing address:
  • Phone: 214-485-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number759787
License Number StateTX

VIII. Authorized Official

Name: MR. MOSES SHEKU MOMOH
Title or Position: COORDINATOR
Credential: RN-BSN
Phone: 315-601-3152