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General NPI Number Information
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NPI Number | 1912459777
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Entity Type | Organization
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Legal Business Name | PURPLE HEARTS CASE MANAGEMENT SERVICES
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 365 UPTOWN BLVD 8102
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City | CEDAR HILL
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State | TX
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Zip | 75104-3514
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Country | US
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Telephone | 214-407-3249
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Fax |
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Provider Business Mailing Address
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Address Line | 365 UPTOWN BLVD 8102
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City | CEDAR HILL
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State | TX
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Zip | 75104-3514
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Country | US
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Telephone | 214-407-3249
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER
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Name | MS. RAVEN ELLIOTT MODISETTE
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Credential | RN
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Telephone | 214-407-3249
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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 | 679455
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License Number State | TX
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