MEDICARE: HIBISCUS RESIDENTIAL CARE AHAOMES

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
1	320700000X	Physical Disabilities Residential Treatment Facility	124051	TX
2	320800000X	Mental Illness Community Based Residential Treatment Facility	124051	TX
3	332BC3200X	Customized Equipment (DME)	124051	TX
4	343900000X	Non-emergency Medical Transport (VAN)	124051	TX

General Provider Information

NPI Number	:	1124282231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIBISCUS RESIDENTIAL CARE AHAOMES

Provider Business Mailing Address
First Line	:	341 MCMURTRY DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4481
Country	:	US
Telephone Number	:	817-719-3022
Fax Number	:	817-719-4128

Provider Business Practice Location Address
First Line	:	341 MCMURTRY DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4481
Country	:	US
Telephone Number	:	817-719-3022
Fax Number	:	817-719-4128

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. MONICA R MOCTAR
Credential	:
Telephone Number	:	817-719-3022

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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