MEDICARE: MRS. LACINDER ROSEANN KING-FULTON PROGRAM DIRECTOR

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	104100000X	Social Worker
3	253Z00000X	In Home Supportive Care Agency
4	311Z00000X	Custodial Care Facility
5	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1942826318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LACINDER ROSEANN KING-FULTON PROGRAM DIRECTOR

Provider Business Mailing Address
First Line	:	5787 S HAMPTON RD STE 203
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-2255
Country	:	US
Telephone Number	:	469-478-0573
Fax Number	:

Provider Business Practice Location Address
First Line	:	5787 S HAMPTON RD STE 203
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-2255
Country	:	US
Telephone Number	:	469-478-0573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	03/23/2026

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