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General NPI Number Information
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NPI Number | 1194912352
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Entity Type | Organization
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Legal Business Name | HERITAGE ADULT DAY HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 150 S BEACH ST SUITE A
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City | FORT WORTH
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State | TX
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Zip | 76105-1162
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Country | US
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Telephone | 817-534-1935
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Fax | 817-531-0282
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Provider Business Mailing Address
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Address Line | PO BOX 50069
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City | FORT WORTH
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State | TX
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Zip | 76105-0069
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Country | US
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Telephone | 817-534-1935
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Fax | 817-531-0282
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Authorized Official
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Title or Position | CONSULTANT
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Name | MS. JOHNNIE MARIE BENSON
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Credential | B.S.-L.N.H.A.
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Telephone | 817-881-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 001536
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License Number State | TX
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