Healthcare Provider Details

I. General information

NPI: 1376456376
Provider Name (Legal Business Name): RDC ACTION GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5581 W HIGHWAY 34
ENNIS TX
75119-1092
US

IV. Provider business mailing address

8101 BOAT CLUB RD STE 240-210
FORT WORTH TX
76179-3630
US

V. Phone/Fax

Practice location:
  • Phone: 214-444-4361
  • Fax:
Mailing address:
  • Phone: 214-444-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID LOPEZ
Title or Position: MEMBER
Credential:
Phone: 469-553-7480