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General NPI Number Information
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NPI Number | 1679349252
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Entity Type | Organization
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Legal Business Name | COMMAND THE LAND VENTURES LLC- AMPLIFY HEALTH PROTECTED SERIES
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 6123 E GRAND AVE
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City | DALLAS
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State | TX
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Zip | 75223-1452
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Country | US
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Telephone | 817-242-9538
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Fax |
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Provider Business Mailing Address
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Address Line | 3540 E BROAD ST STE 120345
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City | MANSFIELD
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State | TX
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Zip | 76063-5633
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Country | US
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Telephone | 817-242-9538
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE WILLIAMS
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Credential |
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Telephone | 817-600-4073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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