Provider Demographics
NPI:1750057469
Name:TRIPLE CROWN CARE
Entity Type:Organization
Organization Name:TRIPLE CROWN CARE
Other - Org Name:HEALING HANDS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OANDAH
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR, OWNER
Authorized Official - Phone:972-433-0604
Mailing Address - Street 1:3600 GUS THOMASSON RD STE 117A
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6729
Mailing Address - Country:US
Mailing Address - Phone:972-433-0604
Mailing Address - Fax:972-360-0780
Practice Address - Street 1:3600 GUS THOMASSON RD STE 117A
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6729
Practice Address - Country:US
Practice Address - Phone:972-433-0604
Practice Address - Fax:972-360-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-22
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty