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General NPI Number Information
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NPI Number | 1649417031
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Entity Type | Organization
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Legal Business Name | INTRUST COMMUNITY SERVICES
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 1521 SUNNY GLEN ST
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City | FORT WORTH
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State | TX
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Zip | 76134-4853
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Country | US
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Telephone | 817-333-4038
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6691
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City | FORT WORTH
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State | TX
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Zip | 76115-0691
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Country | US
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Telephone | 817-333-4038
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. TOMMIE NELL DAVIS
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Credential |
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Telephone | 817-333-4038
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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 | TX
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