Provider Demographics
NPI:1346538279
Name:ADELAIDE HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:ADELAIDE HEALTHCARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-755-9999
Mailing Address - Street 1:1123 WESTMINISTER AVE
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4158
Mailing Address - Country:US
Mailing Address - Phone:214-755-9999
Mailing Address - Fax:214-227-7871
Practice Address - Street 1:1123 WESTMINISTER AVE
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4158
Practice Address - Country:US
Practice Address - Phone:214-755-9999
Practice Address - Fax:214-227-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty