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General NPI Number Information
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NPI Number | 1710784558
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Entity Type | Organization
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Legal Business Name | THE KINDRED ADVANTAGE
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 411 BREEZEWAY CT
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City | CEDAR HILL
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State | TX
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Zip | 75104-6734
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Country | US
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Telephone | 972-504-4074
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Fax | 469-575-4522
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Provider Business Mailing Address
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Address Line | 3424 S COCKRELL HILL RD
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City | DALLAS
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State | TX
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Zip | 75236-1112
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Country | US
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Telephone | 972-998-6901
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. LYNN M CLARK
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Credential | RPH
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Telephone | 972-998-6901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training 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 | 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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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 | 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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