=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043823768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK DEAN LOVING PLACE HCS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2020
-----------------------------------------------------
Last Update Date | 02/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 238 FORDHAM DR
-----------------------------------------------------
City | GLENN HEIGHTS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75154-7908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-285-8795
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 238 FORDHAM DR
-----------------------------------------------------
City | GLENN HEIGHTS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75154-7908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-285-8795
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ ADMIN
-----------------------------------------------------
Name | ERICA WINSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-434-5166
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------