MEDICARE: THRESHOLD COMMUNITY CARE, 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
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1932646916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRESHOLD COMMUNITY CARE, INC

Provider Business Mailing Address
First Line	:	6341 SKYLARK CIR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7850
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6341 SKYLARK CIR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7850
Country	:	US
Telephone Number	:	432-557-2000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STAN TINNEY
Credential	:
Telephone Number	:	432-557-2000

Provider Enumeration Date	:	01/27/2017
Last Update Date	:	01/27/2017

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