Healthcare Provider Details

I. General information

NPI: 1871896696
Provider Name (Legal Business Name): CISNEROS REAL ESTATE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 S ADAMS ST
FORT WORTH TX
76110-3104
US

IV. Provider business mailing address

2940 HEMPHILL ST.
FORT WORTH TX
76110
US

V. Phone/Fax

Practice location:
  • Phone: 817-300-3484
  • Fax: 817-887-3888
Mailing address:
  • Phone: 817-300-3484
  • Fax: 817-887-3888

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: ERICA CISNEROS
Title or Position: OWNER/REAL ESTATE BROKER
Credential:
Phone: 817-300-3484