Healthcare Provider Details

I. General information

NPI: 1720294762
Provider Name (Legal Business Name): MY HEALTH MY RESOURCES OF TARRANT COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HOLLANDALE CIR
ARLINGTON TX
76010-0323
US

IV. Provider business mailing address

PO BOX 2603 HTN, CLIENT ACCOUNTING
FORT WORTH TX
76113-2603
US

V. Phone/Fax

Practice location:
  • Phone: 817-569-4396
  • Fax: 817-569-4517
Mailing address:
  • Phone: 817-569-4396
  • Fax: 817-569-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: YOLANDA MONTES
Title or Position: ENROLLMENT COORDINATOR
Credential:
Phone: 817-569-5235