| NPI | 1912242157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHALITHA SHELBY Program Director 817-729-1150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 251B00000X Case Management |
| 251C00000X | |
| 251S00000X Community/Behavioral Health | |
| 251V00000X Voluntary or Charitable | |
| 253Z00000X In Home Supportive Care | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 347C00000X Private Vehicle | |
| 385HR2050X Respite Care, Respite Care Camp | |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2012-11-28 |