Healthcare Provider Details

I. General information

NPI: 1275537219
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 WESTERN PL STE 105
FORT WORTH TX
76107-4662
US

IV. Provider business mailing address

6100 WESTERN PL STE 105
FORT WORTH TX
76107-4662
US

V. Phone/Fax

Practice location:
  • Phone: 817-870-2795
  • Fax: 817-878-3717
Mailing address:
  • Phone: 817-870-2795
  • Fax: 817-878-3717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number005213
License Number StateTX

VIII. Authorized Official

Name: VICTORIA JINGLE
Title or Position: CEO
Credential:
Phone: 817-989-3260