Healthcare Provider Details

I. General information

NPI: 1518996289
Provider Name (Legal Business Name): TARRANT COUNTY AIDS INTERFAITH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W MAGNOLIA AVE SUITE 102
FORT WORTH TX
76104-7644
US

IV. Provider business mailing address

801 W MAGNOLIA AVE
FORT WORTH TX
76104-4612
US

V. Phone/Fax

Practice location:
  • Phone: 817-665-1323
  • Fax: 817-871-9074
Mailing address:
  • Phone: 817-923-2800
  • Fax: 817-923-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. DAPHNE MYLES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 817-923-2800