Individual
ANDRE ALEXANDER MACEDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1614 SKYLINE DR, GARLAND, TX 75043-1771
(214) 703-5115
Mailing address
1614 SKYLINE DR, GARLAND, TX 75043-1771
(214) 703-5115
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
TX
Other
Enumeration date
01/10/2009
Last updated
01/10/2009
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