Healthcare Provider Details

I. General information

NPI: 1962215848
Provider Name (Legal Business Name): ACCREDIFI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12460 WOODS EDGE TRL
FORT WORTH TX
76244-9408
US

IV. Provider business mailing address

12460 WOODS EDGE TRL
FORT WORTH TX
76244-9408
US

V. Phone/Fax

Practice location:
  • Phone: 817-637-0368
  • Fax:
Mailing address:
  • Phone: 817-637-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DANIETA KAY GRISSMAN
Title or Position: OWNER
Credential: PTA
Phone: 817-637-0363