Provider Demographics
NPI:1285058768
Name:AMPLE HEALTH SERVICES
Entity type:Organization
Organization Name:AMPLE HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:CHIEDOZIE
Authorized Official - Last Name:OSUAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:LPCI/LCDC, MED, MS
Authorized Official - Phone:972-253-0000
Mailing Address - Street 1:2528 NORTH FITZHUGH AVENUE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3387
Mailing Address - Country:US
Mailing Address - Phone:972-253-0000
Mailing Address - Fax:214-823-2550
Practice Address - Street 1:2528 N FITZHUGH AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3387
Practice Address - Country:US
Practice Address - Phone:972-253-0000
Practice Address - Fax:214-823-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70461251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health