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General NPI Number Information
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NPI Number | 1922287655
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Entity Type | Organization
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Legal Business Name | D. B. MONTGOMERY CHOICE , LLC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 4131 HARDEMAN ST
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City | FORT WORTH
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State | TX
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Zip | 76119-3636
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Country | US
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Telephone | 817-534-1426
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Fax | 817-534-1434
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Provider Business Mailing Address
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Address Line | 4131 HARDEMAN ST
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City | FORT WORTH
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State | TX
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Zip | 76119-3636
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Country | US
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Telephone | 817-534-1426
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Fax | 817-534-1434
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Authorized Official
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Title or Position | OWNER
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Name | MR. CLE MONTGOMERY
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Credential |
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Telephone | 469-569-3762
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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 | 121602
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License Number State | TX
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