Organization
DYNAMIQUE HEALTH CARE SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GILLES CEDRICK NWANKEU TALLA (MANAGER)
(817) 805-7905
Entity
Organization
Contact information
Practice address
1544 CONLEY LN, CROWLEY, TX 76036-1503
(817) 805-7905
Mailing address
1544 CONLEY LN, CROWLEY, TX 76036-1503
(817) 805-7905
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
08/20/2024
Last updated
08/20/2024
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