Provider Demographics
NPI:1700408788
Name:PLEASANT CARE BEHAVIORAL HEALTH CARE
Entity Type:Organization
Organization Name:PLEASANT CARE BEHAVIORAL HEALTH CARE
Other - Org Name:PLEASANT CARE BEHAVIORAL HEALTH CLINIC, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:OLAYINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARAMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-222-7063
Mailing Address - Street 1:6916 SEA HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-7280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 MEDICAL CENTRE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4788
Practice Address - Country:US
Practice Address - Phone:682-222-7063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992051411Medicaid