Provider Demographics
NPI:1912459777
Name:PURPLE HEARTS CASE MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:PURPLE HEARTS CASE MANAGEMENT SERVICES
Other - Org Name:PURPLE HEARTS CASE MANAGEMENT SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:MODISETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-407-3249
Mailing Address - Street 1:365 UPTOWN BLVD
Mailing Address - Street 2:8102
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3514
Mailing Address - Country:US
Mailing Address - Phone:214-407-3249
Mailing Address - Fax:
Practice Address - Street 1:365 UPTOWN BLVD
Practice Address - Street 2:8102
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3514
Practice Address - Country:US
Practice Address - Phone:214-407-3249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679455251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management