Healthcare Provider Details

I. General information

NPI: 1205833340
Provider Name (Legal Business Name): WALLS UNIVERSAL HOME HEALTH & HOSPICE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 COUNTRY CLUB LN
FORT WORTH TX
76112-2353
US

IV. Provider business mailing address

1208 COUNTRY CLUB LN
FORT WORTH TX
76112-2353
US

V. Phone/Fax

Practice location:
  • Phone: 817-451-1404
  • Fax: 817-451-5029
Mailing address:
  • Phone: 817-451-1404
  • Fax: 817-451-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number006531
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number006647
License Number StateTX

VIII. Authorized Official

Name: MR. DANNY NACCARATO JR.
Title or Position: VICE PRESIDENT
Credential:
Phone: 817-451-1404