Healthcare Provider Details

I. General information

NPI: 1952602476
Provider Name (Legal Business Name): FST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 02/01/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CORPORATE DR STE 330
IRVING TX
75038-2583
US

IV. Provider business mailing address

PO BOX 471459
FORT WORTH TX
76147-1376
US

V. Phone/Fax

Practice location:
  • Phone: 972-871-1800
  • Fax: 972-871-1802
Mailing address:
  • Phone: 972-871-1800
  • Fax: 972-871-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number013843
License Number StateTX

VIII. Authorized Official

Name: JACK DARRYL GABEHART
Title or Position: PRESIDENT
Credential:
Phone: 972-871-1800