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General NPI Number Information
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NPI Number | 1043698400
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Entity Type | Organization
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Legal Business Name | NEW DESTINY CARE OF DFW-LEWISVILLE
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 500 W MAIN ST SUITE 210
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City | LEWISVILLE
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State | TX
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Zip | 75057-3641
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Country | US
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Telephone | 586-634-0386
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 E TRINITY MILLS RD SUITE 209-168
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City | CARROLLTON
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State | TX
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Zip | 75006-2545
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CLARENCE A PARKS
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Credential | M.D
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Telephone | 815-275-1540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 011002
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License Number State | TX
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