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General NPI Number Information
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NPI Number | 1083362768
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Entity Type | Organization
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Legal Business Name | 4HEALING HEARTS INC
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Dates
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Enumeration Date | 03/12/2022
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Last Update Date | 03/12/2022
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Provider Practice Location Address
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Address Line | 1613 GREENDALE CT
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City | FORT WORTH
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State | TX
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Zip | 76112-3410
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Country | US
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Telephone | 817-680-7912
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Fax | 817-887-2415
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Provider Business Mailing Address
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Address Line | PO BOX 8006
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City | FORT WORTH
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State | TX
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Zip | 76124-0006
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Country | US
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Telephone | 817-680-7912
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Fax | 817-887-2415
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TYIESHA BROWN
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Credential |
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Telephone | 817-680-7912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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