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General NPI Number Information
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NPI Number | 1760934145
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Entity Type | Organization
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Legal Business Name | CANCER CARE SERVICES
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 623 S HENDERSON ST
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City | FORT WORTH
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State | TX
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Zip | 76104-2920
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Country | US
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Telephone | 817-921-0653
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Fax |
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Provider Business Mailing Address
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Address Line | 8106 MELROSE ST E
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City | FORT WORTH
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State | TX
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Zip | 76108-2414
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Country | US
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Telephone | 817-932-4745
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Fax |
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Authorized Official
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Title or Position | CLINIC SOCIAL WORKER/HOOD COUNTY
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Name | MS. CATHERINE ANN PRESLEY
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Credential | LCSW
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Telephone | 682-936-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 37630
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License Number State | TX
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