=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376949677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOWLER CHRISTIAN APARTMENTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2014
-----------------------------------------------------
Last Update Date | 11/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 JULIETTE FOWLER ST
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75214-4876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-821-4061
-----------------------------------------------------
Fax | 214-515-1337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 JULIETTE FOWLER ST
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75214-4876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-821-4061
-----------------------------------------------------
Fax | 214-515-1337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | BILLIE COLLINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-515-1360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 101878
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------