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General NPI Number Information
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NPI Number | 1447052691
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Entity Type | Organization
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Legal Business Name | OUR LOVING ABODE, INC
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 5304 GREENSHAVEN DR
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City | FORT WORTH
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State | TX
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Zip | 76112-8720
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Country | US
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Telephone | 817-714-7069
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Fax |
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Provider Business Mailing Address
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Address Line | 5304 GREENSHAVEN DR
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City | FORT WORTH
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State | TX
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Zip | 76112-8720
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Country | US
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Telephone | 817-714-7069
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MAMIE MINEOR
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Credential |
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Telephone | 817-714-7069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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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 | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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