Healthcare Provider Details

I. General information

NPI: 1518330836
Provider Name (Legal Business Name): MESQUITE TRANSITIONS MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HERITAGE DR
MCKINNEY TX
75069-3256
US

IV. Provider business mailing address

5335 MONTROSE DR
DALLAS TX
75209-5615
US

V. Phone/Fax

Practice location:
  • Phone: 844-633-4663
  • Fax:
Mailing address:
  • Phone: 917-213-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberM3058
License Number StateTX

VIII. Authorized Official

Name: RAVI PATEL
Title or Position: OWNER
Credential:
Phone: 917-213-7366