MEDICARE: NEXPHASE HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1083220024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXPHASE HEALTHCARE

Provider Business Mailing Address
First Line	:	2401 CALLENDER RD STE 109
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-8869
Country	:	US
Telephone Number	:	817-500-7577
Fax Number	:	817-617-2379

Provider Business Practice Location Address
First Line	:	2401 CALLENDER RD STE 109
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-8869
Country	:	US
Telephone Number	:	817-500-7577
Fax Number	:	817-617-2379

Authorized Official
Title or Position	:	OWNER
Name	:	LOVELINE N NCHE
Credential	:
Telephone Number	:	817-500-7577

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	05/13/2024

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Directions to “NEXPHASE HEALTHCARE ” Practice Location

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