Provider Demographics
NPI:1083285878
Name:EL-SHADDAI HEALTHCARE INC
Entity Type:Organization
Organization Name:EL-SHADDAI HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-903-7600
Mailing Address - Street 1:3251 MATLOCK RD APT 22103
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5062
Mailing Address - Country:US
Mailing Address - Phone:214-463-0214
Mailing Address - Fax:214-988-1777
Practice Address - Street 1:6308 AIRES DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-7449
Practice Address - Country:US
Practice Address - Phone:214-463-0214
Practice Address - Fax:214-988-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home