Organization
PURPLE HEARTS INTEGRATED COMMUNITY OUTREACH SERVICES
Active
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
Update your record
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