Healthcare Provider Details

I. General information

NPI: 1205939410
Provider Name (Legal Business Name): VA NORTH TEXAS HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E 9TH ST
BONHAM TX
75418-4059
US

IV. Provider business mailing address

4500 S LANCASTER RD # 11K
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 903-583-6620
  • Fax:
Mailing address:
  • Phone: 214-742-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. BETTY BOLIN-BROWN
Title or Position: DIRECTOR
Credential:
Phone: 214-742-8387