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General NPI Number Information
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NPI Number | 1952434698
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Entity Type | Organization
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Legal Business Name | DEPT OF ASSISTIVE & REHAB SERV - FORT WORTH FIELD HEADQUARTERS
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4200 SOUTH FWY STE 307
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City | FORT WORTH
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State | TX
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Zip | 76115-1404
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Country | US
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Telephone | 817-759-3500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12866
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City | AUSTIN
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State | TX
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Zip | 78711-2866
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Country | US
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Telephone | 512-377-0584
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | JOSEPH PAYNE
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Credential |
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Telephone | 512-424-4092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | TX
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