1720431125 NPI number — FACILITATED, LLC

Table of content: (NPI 1720431125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720431125 NPI number — FACILITATED, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FACILITATED, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720431125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5710 LBJ FREEWAY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-888-8099
Provider Business Mailing Address Fax Number:
214-261-2217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5710 LBJ FREEWAY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-888-8099
Provider Business Practice Location Address Fax Number:
214-261-2217
Provider Enumeration Date:
07/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ALIKHAN
Authorized Official First Name:
NIZAR
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CREDENTIALING CONTACT
Authorized Official Telephone Number:
214-888-8099

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  45D2110102 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 45D2110102 . This is a "CLIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com