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General NPI Number Information
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NPI Number | 1548942279
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Entity Type | Organization
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Legal Business Name | CARING COVENANT COMMUNITY HOME, LLC
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 610 UPTOWN BLVD STE 2000
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City | CEDAR HILL
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State | TX
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Zip | 75104-3528
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Country | US
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Telephone | 817-528-0971
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Fax | 469-779-6112
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Provider Business Mailing Address
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Address Line | PO BOX 1114
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City | LANCASTER
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State | TX
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Zip | 75146-8114
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Country | US
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Telephone | 817-528-0971
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Fax | 469-779-6112
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. ANTOINE MOURY'E BEACHUM
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Credential | CMA
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Telephone | 817-528-0971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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