1861671190 NPI number — ADONAI MEDHEALTH SERVICES, INC

Table of content: (NPI 1861671190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861671190 NPI number — ADONAI MEDHEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADONAI MEDHEALTH SERVICES, INC
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:
6
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:
1861671190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 LEGACY DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75024-2179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-491-2077
Provider Business Mailing Address Fax Number:
972-801-2078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 LEGACY DR
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75024-2179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-801-2086
Provider Business Practice Location Address Fax Number:
972-801-2078
Provider Enumeration Date:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TURNEY
Authorized Official First Name:
MARIBEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
972-491-2077

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: 011942 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253J00000X , with the licence number: 011942 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 011942 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: 011942 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 011942 . This is a "HCSSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 200989601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200989602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45D1079272 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".




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