Provider Demographics
NPI:1225728710
Name:AICARE MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:AICARE MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OBIOMA
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:NWULU
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:469-349-3388
Mailing Address - Street 1:1625 PIKE DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-0706
Mailing Address - Country:US
Mailing Address - Phone:469-349-3388
Mailing Address - Fax:
Practice Address - Street 1:9304 FOREST LN STE S100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6238
Practice Address - Country:US
Practice Address - Phone:469-349-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty