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General NPI Number Information
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NPI Number | 1376751404
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Entity Type | Organization
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Legal Business Name | EASTER SEALS NORTH TEXAS INC.
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 6900 ANDERSON BLVD STE 104
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City | FORT WORTH
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State | TX
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Zip | 76120-3030
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Country | US
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Telephone | 817-332-7171
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Fax | 817-665-0878
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Provider Business Mailing Address
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Address Line | 633 3RD AVE FL 6
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City | NEW YORK
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State | NY
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Zip | 10017-6733
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Country | US
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Telephone | 817-542-1988
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Fax | 817-303-9274
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Authorized Official
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Title or Position | CFO
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Name | CAROL KHOURY
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Credential |
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Telephone | 212-727-4270
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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 |
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License Number State |
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Taxonomy #2
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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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