Provider Demographics
NPI:1689892374
Name:ADONAI FAMILY HEALTH CENTER L.L.C.
Entity Type:Organization
Organization Name:ADONAI FAMILY HEALTH CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ENO
Authorized Official - Last Name:OKPON-ONABAJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-956-5558
Mailing Address - Street 1:1118 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3426
Mailing Address - Country:US
Mailing Address - Phone:972-956-5558
Mailing Address - Fax:972-956-0578
Practice Address - Street 1:1118 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3426
Practice Address - Country:US
Practice Address - Phone:972-956-5558
Practice Address - Fax:972-956-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1890261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176341901Medicaid
TX176341902Medicaid
TX0076MWOtherBLUE SHIELD
TX0076MWOtherBLUE SHIELD
TX00R952Medicare ID - Type UnspecifiedMEDICARE
TX176341902Medicaid
TX176341901Medicaid