Provider Demographics
NPI:1497369474
Name:NEXPHASE HEALTHCARE LLC
Entity Type:Organization
Organization Name:NEXPHASE HEALTHCARE LLC
Other - Org Name:NEXPHASE HEALTHCARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOVELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-500-7577
Mailing Address - Street 1:1201 N WATSON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6120
Mailing Address - Country:US
Mailing Address - Phone:817-500-7577
Mailing Address - Fax:
Practice Address - Street 1:1201 N WATSON RD STE 205
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6120
Practice Address - Country:US
Practice Address - Phone:817-500-7577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-07
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85-2892674OtherIRS