=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710797220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 4 CONNECTION HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2025
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 HALLORAN ST STE 101
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76107-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-789-0140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1916 ADAMS LN
-----------------------------------------------------
City | AZLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76020-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-429-1065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | APRIL REESE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 505-429-1065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------