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Organization

PURPLE HEARTS INTEGRATED COMMUNITY OUTREACH SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RAVEN ELLIOTT MODISETTE FNP-C, PMHNP-BC (CEO)
(214) 412-3523
Entity
Organization

Contact information

Practice address
688 W PIONEER PKWY STE 120, GRAND PRAIRIE, TX 75051-4861
(214) 412-3523
(214) 710-2188
Mailing address
688 W PIONEER PKWY STE 120, GRAND PRAIRIE, TX 75051-4861
(214) 412-3523
(214) 710-2188

Taxonomy

Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary

Other

Enumeration date
07/13/2023
Last updated
07/13/2023
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