Healthcare Provider Details

I. General information

NPI: 1669737912
Provider Name (Legal Business Name): TRINITY RIVER ADULT DAYCARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N RIVERSIDE DR
FORT WORTH TX
76111
US

IV. Provider business mailing address

1401 CLINTON AVE
FORT WORTH TX
76164-9143
US

V. Phone/Fax

Practice location:
  • Phone: 817-740-1611
  • Fax:
Mailing address:
  • Phone: 817-740-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. VERONICA ALANIZ
Title or Position: OWNER/OPERATOR
Credential: LVN
Phone: 817-740-1611