Provider Demographics
NPI:1316306954
Name:DOVE HEIGHT LLC
Entity type:Organization
Organization Name:DOVE HEIGHT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:NAA-AKANYO
Authorized Official - Last Name:BOYEFIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-587-4163
Mailing Address - Street 1:402 AMARA CRES
Mailing Address - Street 2:E
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-9011
Mailing Address - Country:US
Mailing Address - Phone:469-587-4163
Mailing Address - Fax:
Practice Address - Street 1:402 AMARA CRES
Practice Address - Street 2:E
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-9011
Practice Address - Country:US
Practice Address - Phone:469-587-4163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802371945251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX802371945Medicaid