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Organization
PREMIUM ASSISTED CARE
Active
Organization
PREMIUM ASSISTED CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DORIS MAE GORDON (PROGRAM MANAGER (OWNER))
(214) 808-6070
Entity
Organization
Contact information
Practice address
549 HILLCREST DR, GARLAND, TX 75040-5618
(214) 808-6070
Mailing address
333 LOMA ALTA DR, MESQUITE, TX 75150-3185
(214) 808-6070
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
978967170
UNITED HEALTHCARE
TX
Enumeration date
10/25/2011
Last updated
10/25/2011
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