Glaster Wheeler Hicks

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

308453 Issued in TX

Practice address

5117 Rocky Ridge Rd
Dallas, TX 75241-1023

Phone

(214) 434-1583

NPI assigned

Dec 16, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• A Roosevelt Residential Care

  • Assisted Living Facility
  • Dallas, TX
  • NPI 1962125302
  NPD Authorized official

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

{
    "created_epoch": "1639612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1790444834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 398706",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753398706",
            "telephone_number": "214-850-8318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5117 ROCKY RIDGE RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752411023",
            "telephone_number": "214-434-1583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "GLASTER",
        "middle_name": "WHEELER",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-16",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "308453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "64:76:ba:b6:09:12",
            "affiliation": "N",
            "endpointDescription": "The Media Access Control address for this hardware is 64:76:ba:b6:09:12",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "Excel",
            "address_1": "5117 Rocky Ridge Rd",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752411023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Corneshia Hicks
• Courtney Ann Hicks, LMFT - SUPERVISOR
• Craig Hicks
• Dominic Hicks, COTA
• Donna June Hicks, N.D
• Hadlee Hicks
• Jocelyn Marie Hicks, LCSW
• Kismit Hicks, SLP
• Linda L. Hicks, CRNA
• Michael Ray Hicks, M.D.

• Assisted Living Facility in Dallas, TX
• Providers in Dallas, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; 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.