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General NPI Number Information
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NPI Number | 1861709594
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE ADULT DAYCARE CENTER, INC.
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 1700 SOUTH FWY
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City | FORT WORTH
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State | TX
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Zip | 76104-5078
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Country | US
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Telephone | 817-740-1611
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Fax | 817-740-1667
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Provider Business Mailing Address
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Address Line | 1401 CLINTON AVE
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City | FORT WORTH
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State | TX
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Zip | 76164-9143
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Country | US
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Telephone | 817-740-1611
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Fax | 817-740-1667
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Authorized Official
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Title or Position | OWNER
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Name | MRS. VERONICA ALANIZ
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Credential | LVN
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Telephone | 817-740-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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