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General NPI Number Information
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NPI Number | 1114123015
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL CARE FACILITY
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 6327 TEAGUE DR
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City | DALLAS
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State | TX
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Zip | 75241-4844
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Country | US
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Telephone | 214-372-3690
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Fax | 972-224-5589
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Provider Business Mailing Address
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Address Line | 6327 TEAGUE DR
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City | DALLAS
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State | TX
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Zip | 75241-4844
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Country | US
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Telephone | 214-372-3690
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Fax | 972-224-5589
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LATONDRA DENISE ASKEW
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Credential |
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Telephone | 469-877-8557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 030258
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License Number State | TX
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