1609174812 NPI number — BELINDA ELOISE ALBRIGHT

Table of content: (NPI 1609174812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609174812 NPI number — BELINDA ELOISE ALBRIGHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELINDA ELOISE ALBRIGHT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALBRIGHT FOSTER CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609174812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7636 RED WILLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76133-7571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-294-5915
Provider Business Mailing Address Fax Number:
817-294-3742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7636 RED WILLOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76133-7571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-294-5915
Provider Business Practice Location Address Fax Number:
817-294-3742
Provider Enumeration Date:
03/11/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALBRIGHT
Authorized Official First Name:
BELINDA
Authorized Official Middle Name:
ELOISE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-294-5915

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  129193 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000686400 . This is a "DEPT AGED & DISABLED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000686300 . This is a "RESPITE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000686300 . This is a "DEPT AGED & DISABLED SERVICE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000686400 . This is a "CCAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0006864000 . This is a "MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000686400 . This is a "CBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".