MEDICARE: MY HEALTH MY RESOURCES OF TARRANT COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063628923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY HEALTH MY RESOURCES OF TARRANT COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 2603
Second Line	:	HTN, CLIENT ACCOUNTING
City	:	FORT WORTH
State	:	TX
Zip	:	76113-2603
Country	:	US
Telephone Number	:	817-569-4396
Fax Number	:	817-569-4517

Provider Business Practice Location Address
First Line	:	1619 PIPELINE RD E
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-7661
Country	:	US
Telephone Number	:	817-569-4396
Fax Number	:	817-569-4517

Authorized Official
Title or Position	:	ENROLLMENT COORDINATOR
Name	:	YOLANDA MONTES
Credential	:
Telephone Number	:	817-569-5235

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/18/2021

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