Organization
CENTRICARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIVINE NYIAWUNG (PRESIDENT)
(214) 984-1306
Entity
Organization
Contact information
Practice address
2820 PARK PLACE DR, GRAND PRAIRIE, TX 75052-8521
(214) 984-1306
(214) 984-1306
Mailing address
2820 PARK PLACE DR, GRAND PRAIRIE, TX 75052-8521
(214) 984-1306
(214) 984-1306
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
10/02/2019
Last updated
10/02/2019
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