Healthcare Provider Details

I. General information

NPI: 1124282231
Provider Name (Legal Business Name): HIBISCUS RESIDENTIAL CARE AHAOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 MCMURTRY DR
ARLINGTON TX
76002-4481
US

IV. Provider business mailing address

341 MCMURTRY DR
ARLINGTON TX
76002-4481
US

V. Phone/Fax

Practice location:
  • Phone: 817-719-3022
  • Fax: 817-719-4128
Mailing address:
  • Phone: 817-719-3022
  • Fax: 817-719-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number124051
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number124051
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number124051
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number124051
License Number StateTX

VIII. Authorized Official

Name: MRS. MONICA R MOCTAR
Title or Position: MANAGER
Credential:
Phone: 817-719-3022