Healthcare Provider Details

I. General information

NPI: 1205264801
Provider Name (Legal Business Name): ORAAC HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 ALMA DR # 105-181
PLANO TX
75025-3482
US

IV. Provider business mailing address

7801 ALMA DR # 105-181
PLANO TX
75025-3482
US

V. Phone/Fax

Practice location:
  • Phone: 501-837-1055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number057
License Number StateAR

VIII. Authorized Official

Name: EMMANUEL ILODIANYA
Title or Position: PROGRAM MANAGER
Credential: M.A.
Phone: 501-837-1055