Provider Demographics
NPI:1922374073
Name:ADVANCE ADAPTIVE GROWTH AND DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:ADVANCE ADAPTIVE GROWTH AND DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-226-8759
Mailing Address - Street 1:13000 VASSAR DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2234
Mailing Address - Country:US
Mailing Address - Phone:817-226-8759
Mailing Address - Fax:817-466-8756
Practice Address - Street 1:13000 VASSAR DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-2234
Practice Address - Country:US
Practice Address - Phone:817-226-8759
Practice Address - Fax:817-466-8756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014342310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility