Provider Demographics
NPI:1558996124
Name:CREDENCE HOME AND COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:CREDENCE HOME AND COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALOYSIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:JINGWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-971-1584
Mailing Address - Street 1:3103 ANTELOPE DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-3671
Mailing Address - Country:US
Mailing Address - Phone:214-497-1158
Mailing Address - Fax:
Practice Address - Street 1:3103 ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-3671
Practice Address - Country:US
Practice Address - Phone:214-971-1584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health