Centricare LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

CENTRICARE LLC

Practice address

2820 Park Place Dr
Grand Prairie, TX 75052-8521

Phone

(214) 984-1306

Fax

(214) 984-1306

NPI assigned

Oct 2, 2019

Last updated

Oct 2, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Divine Nyiawung

Title

President

Phone

(214) 984-1306

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569974400000",
    "number": "1215578059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 PARK PLACE DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750528521",
            "telephone_number": "214-984-1306",
            "fax_number": "214-984-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 PARK PLACE DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750528521",
            "telephone_number": "214-984-1306",
            "fax_number": "214-984-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRICARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-02",
        "last_updated": "2019-10-02",
        "status": "A",
        "authorized_official_last_name": "NYIAWUNG",
        "authorized_official_first_name": "DIVINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-984-1306"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Adult Care Home Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.