Provider Demographics
NPI:1316270622
Name:CAREDRIVE HEALTHCARE GROUP
Entity type:Organization
Organization Name:CAREDRIVE HEALTHCARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-275-7979
Mailing Address - Street 1:381 CASA LINDA PLZ
Mailing Address - Street 2:SUITE 123
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-5004
Mailing Address - Country:US
Mailing Address - Phone:214-275-7979
Mailing Address - Fax:
Practice Address - Street 1:381 CASA LINDA PLZ
Practice Address - Street 2:SUITE 123
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-5004
Practice Address - Country:US
Practice Address - Phone:214-275-7979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty