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General NPI Number Information
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NPI Number | 1407180292
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Entity Type | Organization
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Legal Business Name | CHRITIAN LOVE FOUNDATION
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 6325 VEL DR
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City | FORT WORTH
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State | TX
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Zip | 76112-8035
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Country | US
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Telephone | 817-703-5605
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40013
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City | FORT WORTH
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State | TX
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Zip | 76140-0013
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Country | US
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Telephone | 817-703-5605
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. ROSALYN HUBBARD
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Credential |
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Telephone | 817-703-5605
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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 |
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License Number State | TX
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