Healthcare Provider Details

I. General information

NPI: 1083872014
Provider Name (Legal Business Name): ALLSTATE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4506 VAUGHAN DR
ROWLETT TX
75088-7503
US

IV. Provider business mailing address

PO BOX 1862
ROWLETT TX
75030-1862
US

V. Phone/Fax

Practice location:
  • Phone: 972-475-3358
  • Fax: 972-475-3385
Mailing address:
  • Phone: 972-475-3358
  • Fax: 972-475-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0084934
License Number StateTX

VIII. Authorized Official

Name: STELLA U HAIRSTON
Title or Position: CEO
Credential:
Phone: 972-475-3358