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General NPI Number Information
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NPI Number | 1790251593
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Entity Type | Individual
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Provider Name | CHRISTOPHER JONES LICENSE PROVIDER
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Gender | Male
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 03/20/2022
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Provider Practice Location Address
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Address Line | 6405 GREENBRIAR LN
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City | FORT WORTH
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State | TX
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Zip | 76132-3037
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Country | US
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Telephone | 817-991-2768
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Fax | 817-534-5771
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Provider Business Mailing Address
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Address Line | 6405 GREENBRIAR LN
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City | FORT WORTH
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State | TX
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Zip | 76132-3037
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Country | US
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Telephone | 817-991-2768
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Fax | 817-534-5771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 146250
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License Number State | TX
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