Healthcare Provider Details

I. General information

NPI: 1790115970
Provider Name (Legal Business Name): BLESSED B'YOND MEASURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 DILLARD ST
FT WORTH TX
76105-4536
US

IV. Provider business mailing address

2604 DILLARD ST
FT WORTH TX
76105-4536
US

V. Phone/Fax

Practice location:
  • Phone: 817-705-9886
  • Fax:
Mailing address:
  • Phone: 817-705-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. AMBER ELIZABETH TAVE
Title or Position: OWNER
Credential:
Phone: 817-298-4676