Provider Demographics
NPI:1689302861
Name:ACTFAST HEALTHCARE LLC
Entity Type:Organization
Organization Name:ACTFAST HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BLESSING
Authorized Official - Middle Name:OKON
Authorized Official - Last Name:OKPO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:972-891-1700
Mailing Address - Street 1:2000 E ARAPAHO RD APT 22303
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-7709
Mailing Address - Country:US
Mailing Address - Phone:972-891-1700
Mailing Address - Fax:
Practice Address - Street 1:2000 E ARAPAHO RD APT 22303
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-7709
Practice Address - Country:US
Practice Address - Phone:945-249-0615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service