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General NPI Number Information
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NPI Number | 1053918151
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Entity Type | Organization
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Legal Business Name | THE SALVATION ARMY, A GEORGIA CORP. - MABEE CENTER
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 1855 E. LANCASTER AVE.
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City | FORT WORTH
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State | TX
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Zip | 76103-2123
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Country | US
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Telephone | 817-344-1831
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Fax | 817-338-9251
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Provider Business Mailing Address
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Address Line | 1855 E. LANCASTER AVE.
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City | FORT WORTH
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State | TX
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Zip | 76103-2123
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Country | US
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Telephone | 817-344-1831
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Fax | 817-338-9251
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Authorized Official
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Title or Position | ASSISTANT TREASURER
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Name | AUSTRUBERTO FLORES III
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Credential |
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Telephone | 404-728-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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