Healthcare Provider Details

I. General information

NPI: 1457759045
Provider Name (Legal Business Name): KYLIE'S ADULT DAYCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 US HIGHWAY 80 E 305
MESQUITE TX
75150-3359
US

IV. Provider business mailing address

4593 MOUNTAIN LAUREL DR
GRAND PRAIRIE TX
75052-2903
US

V. Phone/Fax

Practice location:
  • Phone: 972-805-6674
  • Fax: 972-698-0844
Mailing address:
  • Phone: 972-805-6674
  • Fax: 972-698-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. NGOZI TILLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-742-9407