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General NPI Number Information
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NPI Number | 1104666551
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Entity Type | Organization
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Legal Business Name | SELAH HEALTH
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 5752 GRANDSCAPE BLVD STE 225
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City | THE COLONY
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State | TX
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Zip | 75056-6772
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Country | US
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Telephone | 972-900-1881
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Fax |
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Provider Business Mailing Address
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Address Line | 5752 GRANDSCAPE BLVD STE 225
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City | THE COLONY
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State | TX
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Zip | 75056-6772
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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 AND PRESIDENT
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Name | DALTON DIVAKARAN
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Credential |
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Telephone | 972-900-1881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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