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General NPI Number Information
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NPI Number | 1346538279
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Entity Type | Organization
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Legal Business Name | ADELAIDE HEALTHCARE GROUP, LLC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 1123 WESTMINISTER AVE
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City | MURPHY
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State | TX
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Zip | 75094-4158
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Country | US
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Telephone | 214-755-9999
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Fax | 214-227-7871
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Provider Business Mailing Address
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Address Line | 1123 WESTMINISTER AVE
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City | MURPHY
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State | TX
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Zip | 75094-4158
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Country | US
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Telephone | 214-755-9999
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Fax | 214-227-7871
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JACKSON JACOB
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Credential |
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Telephone | 214-755-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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