Provider Demographics
NPI:1043368673
Name:CITADEL HAELTHCARE SERVICES INC
Entity type:Organization
Organization Name:CITADEL HAELTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:UDUAK
Authorized Official - Middle Name:E
Authorized Official - Last Name:INYANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-349-5900
Mailing Address - Street 1:12959 JUPITER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5223
Mailing Address - Country:US
Mailing Address - Phone:214-349-5900
Mailing Address - Fax:214-349-5944
Practice Address - Street 1:12959 JUPITER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5223
Practice Address - Country:US
Practice Address - Phone:214-349-5900
Practice Address - Fax:214-349-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009243251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457813Medicare ID - Type Unspecified