MEDICARE: CDHS INC.

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	261QM2800X	Methadone Clinic	0000047	TX

General Provider Information

NPI Number	:	1669703328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDHS INC.

Provider Business Mailing Address
First Line	:	214 BILLINGS ST STE 240
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5404
Country	:	US
Telephone Number	:	817-652-1004
Fax Number	:	817-652-1016

Provider Business Practice Location Address
First Line	:	214 BILLINGS ST STE 240
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5404
Country	:	US
Telephone Number	:	817-652-1004
Fax Number	:	817-652-1016

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JANICE D DOLAN
Credential	:	LCDC,ADC LEVEL III
Telephone Number	:	817-652-1004

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	01/20/2010

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