=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780028381
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TARRANT COUNTY SAMARITAN HOUSING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2013
-----------------------------------------------------
Last Update Date | 04/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 929 HEMPHILL ST
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-332-6410
-----------------------------------------------------
Fax | 817-332-6409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 929 HEMPHILL ST
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-332-6410
-----------------------------------------------------
Fax | 817-332-6409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT & COO
-----------------------------------------------------
Name | MRS. TED A LOVATO
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 817-332-6410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number | 022
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------