=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699041038
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WE CARE HOUSE GROUP, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2012
-----------------------------------------------------
Last Update Date | 03/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 N WATSON RD SUITE 299
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76006-6190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-475-8039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 92547
-----------------------------------------------------
City | SOUTHLAKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76092-0547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/CEO
-----------------------------------------------------
Name | DR. ADETUNJI ADESANOYE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-475-8039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | N0590
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------