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General NPI Number Information
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NPI Number | 1134405566
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Entity Type | Organization
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Legal Business Name | LIFECENTER SKILLS FOR DEVELOPMENT
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 9304 FOREST LANE SUITE N271
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City | DALLAS
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State | TX
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Zip | 75243
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Country | US
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Telephone | 469-438-2574
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Fax | 972-584-9905
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Provider Business Mailing Address
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Address Line | 9304 FOREST LANE SUITE N271
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City | DALLAS
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State | TX
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Zip | 75243
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Country | US
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Telephone | 469-438-2574
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Fax | 972-584-9905
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. TEIZO DEVOTNAE ADKISON
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Credential |
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Telephone | 469-438-2574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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