Healthcare Provider Details

I. General information

NPI: 1568899607
Provider Name (Legal Business Name): FCN OF TEXAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 E PLEASANT RUN RD SUITE 124
DESOTO TX
75115-4209
US

IV. Provider business mailing address

1229 E PLEASANT RUN RD SUITE 124
DESOTO TX
75115-4209
US

V. Phone/Fax

Practice location:
  • Phone: 469-774-3053
  • Fax:
Mailing address:
  • Phone: 469-774-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: MRS. DEMETRA L DONALDSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 469-774-3053