Organization
IMPALA CARE HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MUGOMOKE (OWNER)
(469) 910-4181
Entity
Organization
Contact information
Practice address
444 W COMMERCE STREET, APT 3123, DALLAS, TX 75208
(469) 910-4181
Mailing address
444 W COMMERCE STREET, APT 3123, DALLAS, TX 75208
(469) 910-4181
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/14/2021
Last updated
05/14/2021
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