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General NPI Number Information
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NPI Number | 1285761999
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Entity Type | Organization
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Legal Business Name | AIDS OUTREACH CENTER
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 400 NORTH BEACH STREET
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City | FORT WORTH
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State | TX
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Zip | 76111
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Country | US
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Telephone | 817-335-1994
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Fax | 817-335-3617
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Provider Business Mailing Address
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Address Line | 400 NORTH BEACH STREET
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City | FORT WORTH
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State | TX
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Zip | 76111
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Country | US
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Telephone | 817-335-1994
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Fax | 817-335-3617
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Authorized Official
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Title or Position | ASSOCIATE EXECUTIVE DIRECTOR
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Name | MS. MELLISAND LE ROY
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Credential |
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Telephone | 817-335-1994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NA
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License Number State | TX
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