Healthcare Provider Details

I. General information

NPI: 1124317094
Provider Name (Legal Business Name): SABINA PAD ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E SPRING CREEK PKWY APT 1134 # 1134
PLANO TX
75074-3220
US

IV. Provider business mailing address

1800 E SPRING CREEK PKWY APT 1134 # 1134
PLANO TX
75074-3220
US

V. Phone/Fax

Practice location:
  • Phone: 214-603-3716
  • Fax:
Mailing address:
  • Phone: 214-603-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KAYODE FRANK OLOPADE
Title or Position: CEO
Credential:
Phone: 214-603-3716