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General NPI Number Information
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NPI Number | 1417273350
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Entity Type | Organization
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Legal Business Name | JUSSAFE ADULT FOSTER CARE
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Dates
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Enumeration Date | 04/16/2010
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Last Update Date | 04/16/2010
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Provider Practice Location Address
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Address Line | 8945 PREAKNESS CIR
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City | FORT WORTH
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State | TX
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Zip | 76123-3582
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Country | US
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Telephone | 214-680-4815
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Fax |
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Provider Business Mailing Address
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Address Line | 8945 PREAKNESS CIR
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City | FORT WORTH
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State | TX
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Zip | 76123-3582
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Country | US
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Telephone | 214-680-4815
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KRISTINA M ROBERTS-WYNN
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Credential |
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Telephone | 214-680-4815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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