Healthcare Provider Details

I. General information

NPI: 1902043276
Provider Name (Legal Business Name): BEAUTIFUL BEGINNINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 TIERNEY RD
FORT WORTH TX
76112-6324
US

IV. Provider business mailing address

420 TIERNEY RD
FORT WORTH TX
76112-6324
US

V. Phone/Fax

Practice location:
  • Phone: 817-534-5480
  • Fax: 817-534-4748
Mailing address:
  • Phone: 817-534-5480
  • Fax: 817-534-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DORIS BENJAMIN
Title or Position: PROGRAN MANAGER
Credential:
Phone: 817-534-5480