=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023076908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH CENTRAL TEXAS HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5608 MALVEY AVE SUITE 300
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76107-5100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-377-0880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5608 MALVEY AVE SUITE 300
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76107-5100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-377-0880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. DIANA FARMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-377-0880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 002698
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------