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NPI Code Detail

MEDICARE: 4HEALING HEARTS INC

MEDICARE: 4HEALING HEARTS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2253J00000XFoster Care Agency
3261QM0855XAdolescent and Children Mental Health Clinic/Center
41041C0700XClinical Social Worker
5322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number : 1083362768
Entity Type Code : Organization
Provider Name (Legal Business Name) : 4HEALING HEARTS INC
Provider Business Mailing Address
First Line : PO BOX 8006
Second Line :
City : FORT WORTH
State : TX
Zip : 76124-0006
Country : US
Telephone Number : 817-680-7912
Fax Number : 817-887-2415
Provider Business Practice Location Address
First Line : 1613 GREENDALE CT
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-3410
Country : US
Telephone Number : 817-680-7912
Fax Number : 817-887-2415
Authorized Official
Title or Position : ADMINISTRATOR
Name : TYIESHA BROWN
Credential :
Telephone Number : 817-680-7912
Provider Enumeration Date : 03/12/2022
Last Update Date : 03/12/2022

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