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General NPI Number Information
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NPI Number | 1679694913
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Entity Type | Organization
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Legal Business Name | FAMILY OUTREACH & RESOURCE, INC.
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 910 COURT DR
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City | PALESTINE
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State | TX
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Zip | 75803-3920
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Country | US
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Telephone | 903-723-8294
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Fax | 903-723-6308
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Provider Business Mailing Address
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Address Line | 910 COURT DR
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City | PALESTINE
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State | TX
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Zip | 75803-3920
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Country | US
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Telephone | 903-723-8294
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | MR. CARL E DAVIS SR.
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Credential |
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Telephone | 903-723-7486
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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 | 119894
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License Number State | TX
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