Healthcare Provider Details

I. General information

NPI: 1033391529
Provider Name (Legal Business Name): YETKIN ADVANCED HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 EXECUTIVE WAY STE 200
DESOTO TX
75115-2308
US

IV. Provider business mailing address

115 EXECUTIVE WAY STE 200
DESOTO TX
75115-2308
US

V. Phone/Fax

Practice location:
  • Phone: 972-564-3471
  • Fax: 972-552-3610
Mailing address:
  • Phone: 972-564-3471
  • Fax: 972-552-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. ALFRED AKINOLA
Title or Position: ONWER/ADMINISTRATOR
Credential:
Phone: 214-695-0112