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General NPI Number Information
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NPI Number | 1316327869
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Entity Type | Organization
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Legal Business Name | HOBERT SOUL FOOD CANTEEN
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Dates
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Enumeration Date | 05/30/2015
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Last Update Date | 05/30/2015
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Provider Practice Location Address
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Address Line | 4023 E BERRY ST
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City | FORT WORTH
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State | TX
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Zip | 76105-4955
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Country | US
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Telephone | 817-919-5050
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Fax | 817-549-7396
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Provider Business Mailing Address
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Address Line | PO BOX 163127
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City | FORT WORTH
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State | TX
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Zip | 76161-3127
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Country | US
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Telephone | 817-919-5050
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Fax | 817-549-7396
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Authorized Official
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Title or Position | OWNER
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Name | MISS N LUCILLE GILKEY
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Credential |
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Telephone | 817-919-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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