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General NPI Number Information
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NPI Number | 1942826318
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Entity Type | Individual
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Provider Name | LACINDER ROSEANN KING-FULTON PROGRAM DIRECTOR
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Gender | Female
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 1205 SWITCHGRASS LN
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City | CROWLEY
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State | TX
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Zip | 76036-4341
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Country | US
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Telephone | 469-478-0573
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 SWITCHGRASS LN
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City | CROWLEY
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State | TX
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Zip | 76036-4341
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Country | US
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Telephone | 469-478-0573
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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Taxonomy #4
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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Taxonomy #5
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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