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General NPI Number Information
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NPI Number | 1962895839
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Entity Type | Organization
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Legal Business Name | MABEL THOMAS
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 5401 WOODWAY DR
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City | FORT WORTH
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State | TX
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Zip | 76133-2035
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Country | US
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Telephone | 817-479-9800
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Fax | 817-479-9806
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Provider Business Mailing Address
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Address Line | PO BOX 174133
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City | ARLINGTON
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State | TX
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Zip | 76003-4133
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Country | US
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Telephone | 817-945-6338
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Fax | 817-479-9806
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROBERT GRIFFIN
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Credential |
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Telephone | 817-945-6338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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