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General NPI Number Information
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NPI Number | 1215174727
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Entity Type | Organization
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Legal Business Name | TANDY VILLAGE ASSISTED LIVING
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 2601 TANDY AVE
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City | FORT WORTH
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State | TX
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Zip | 76103-2552
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Country | US
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Telephone | 817-535-1253
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Fax | 817-536-0177
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Provider Business Mailing Address
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Address Line | 2601 TANDY AVE
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City | FORT WORTH
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State | TX
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Zip | 76103-2552
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Country | US
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Telephone | 817-535-1253
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Fax | 817-536-0177
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MS. NELLIE S. QUETON
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Credential |
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Telephone | 817-535-1253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 125808
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License Number State | TX
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