EXECUTIVE DE-TAILS


Address: 2952 Celian Dr, Grand Prairie, TX 75052-8737
Phone: 8172475267

EXECUTIVE DE-TAILS (NPI# 1629134440) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1629134440
Entity Type Organization
Organization Name EXECUTIVE DE-TAILS
Other Organization Name EXECUTIVE DE-TAILS
Practice Address 2952 Celian Dr
Grand Prairie
TX 75052-8737
Practice Telephone 8172475267
Enumeration Date 2006-12-28
Last Update Date 2020-08-22
Authorized Official Name MR. MARK AIDELOJIE (CONSULTANT)
Authorized Official Telephone 8172742284
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 171W00000X Contractor Other Service Providers

Other Provider/Organization Names

Other Name Type Code
Executive De-Tails Doing Business As Name - Organization

Office Location

Street Address 2952 CELIAN DR
City GRAND PRAIRIE
State TX
Zip Code 75052-8737

Providers in the same location

NPI Name Taxonomy Address Enumeration
1710119052 D&d Residential Services Inc Nursing Care 2952 Celian Dr, Grand Prairie, TX 75052-8737 2009-08-20

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1487265542 Beyond Home Health Care LLC Registered Nurse 3531 Pecos Way, Grand Prairie, TX 75052 2020-08-12
1497370332 Michael Cooper Dentist 3154 South Hwy 161 Ste 640, Grand Prairie, TX 75052 2020-06-16
1043835788 Amanda Azubike Licensed Practical Nurse 4593 Mt Laurel Dr, Grand Prairie, TX 75052 2020-06-09
1457992844 Epic West Family Dnetistry Pllc Dentist 3166 Sh 161, Ste 190, Grand Prairie, TX 75052 2019-10-07
1033777487 National Vision Inc Optometrist 3166 South Highway 161, Suite 160, Grand Prairie, TX 75052 2019-05-31
1689136624 Raushanah Taherrah Shareef-jefferson Dental Hygienist 831 Ridgecrest Rd, Grand Prairie, TX 75052 2019-04-01
1053812552 Dfw Better Care Physicians, Pllc Clinic/Center 5204 Tx 360 #400, Grand Prairie, TX 75052 2018-02-21
1629586797 Grand Prairie Marvel Dental Pllc Clinic/Center 5020 S Hwy 360, Suite 200, Grand Prairie, TX 75052 2018-01-11
1033626221 Thad Taylor Iv Dds Dentist 3261 S. Carrier Pkwy., Grand Prairie, TX 75052 2018-01-09
1902312796 Real Dental Pllc Dentist 1215 W. Pioneer Pkwy, Suite 130, Grand Prairie, TX 75052 2017-12-16
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Taxonomy Information

Taxonomy Code 171W00000X
Grouping Other Service Providers
Classification Contractor

Taxonomy Definition

A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering).
Notes: Source: Websters New World Dictionary of the American Language, Second College Edition, William Collins + World Publishing Co., Inc., New York: 1974, p. 308

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1104308931 Reginah Mbula Ngwili Contractor 3318 Spring Meadow Ln, Grand Prairie, TX 75052-6482 2018-08-29
1396111019 Tommy Lee Provost Contractor 5832 Midnight Ln, Grand Prairie, TX 75052-8585 2015-08-17
1073829883 Marcie Frazier-martin Contractor 2768 Park Pl, Grand Prairie, TX 75052-8582 2010-08-31
1710126230 Claude Russell Trotter IIi Contractor 674 W Warrior Trl, Grand Prairie, TX 75052-6099 2009-02-05
1861639718 Jacqueline Lanae Fort Contractor 842 Pangburn St, Grand Prairie, TX 75051 2009-01-14
1134200389 Sharon Ruth Jackson Contractor 2100 N. Hwy 360, Suite 1704, Grand Prairie, TX 75050-1062 2006-10-17
1801904644 Dwight Lee Contractor 4223 Cedar Ridge Dr, Grand Prairie, TX 75052-2819 2006-08-29
1013933084 Deborah A Burns Contractor 3122 S Holiday Dr, Grand Prairie, TX 75052-5857 2006-07-14
1598916991 Moses B Fagbeyiro Contractor 2516 Wayne Way, Grand Prairie, TX 75052-7883 2008-10-03

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1174123228 D and J Development Contractor 3016 N I 35 E, Lancaster, TX 75134-1851 2020-10-28
1427657659 Mipcn, Inc. Contractor 9305 Hammerly Blvd, Houston, TX 77080-5413 2020-10-19
1497353569 Mark Sanders Contractor 3046 Fordham Rd, Dallas, TX 75216-4819 2020-10-12
1215534227 Michael Clark Contractor 1107 Lavender Shade Court, Houston, TX 77073 2020-10-02
1235744244 Dignity Services LLC Contractor 1001 N Medford Rd, Brownsville, TX 78521-8474 2020-09-15
1568076826 Hanaa Mohammed Contractor 6825 Huebner Rd # 680012, San Antonio, TX 78238-2108 2020-09-03
1609487107 Lateshna D Oliver Contractor 1714 7th St, Wichita Falls, TX 76301-4223 2020-08-10
1588282354 Tenzie May Contractor 5413 Mansel Ln, Fort Worth, TX 76134-1615 2020-07-08
1720605116 Physmedics LLC Contractor 10900 Research Blvd., Ste 160-c, #3, Austin, TX 78759-5718 2020-07-01
1609493444 Kizzey Ann Collins Contractor 810 Skyline Trl, Houston, TX 77019-2950 2020-06-27
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Competitor

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City GRAND PRAIRIE
Zip Code 75052

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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