=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740727320
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAC CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2017
-----------------------------------------------------
Last Update Date | 01/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 VALWOOD PKWY STE NO. 20-170A
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-8312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-803-2030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1408 N RIVERFRONT BLVD STE 306
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75207-3912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-803-2030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | DR. GEORGE CHRISTAFA BONE
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 214-803-2030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | AP121905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------