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General NPI Number Information
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NPI Number | 1568829125
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Entity Type | Organization
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Legal Business Name | DAVIDSTAR ENTERPRISES
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 4337 COUNTRY CLUB DR
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City | PLANO
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State | TX
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Zip | 75074-3610
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Country | US
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Telephone | 214-560-7351
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Fax |
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Provider Business Mailing Address
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Address Line | 4337 COUNTRY CLUB DR
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City | PLANO
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State | TX
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Zip | 75074-3610
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Country | US
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Telephone | 214-560-7351
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JEMIMA MOISE
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Credential | COTA
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Telephone | 214-926-7284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 32059276298
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License Number State |
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