Provider Demographics
NPI:1093856924
Name:LENA POPE HOME, INC.
Entity Type:Organization
Organization Name:LENA POPE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MERRY
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:ELGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-255-2500
Mailing Address - Street 1:3200 SANGUINET ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5355
Mailing Address - Country:US
Mailing Address - Phone:817-255-2652
Mailing Address - Fax:817-255-2657
Practice Address - Street 1:3200 SANGUINET ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5355
Practice Address - Country:US
Practice Address - Phone:817-255-2652
Practice Address - Fax:817-255-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108336204Medicaid
TX108336205Medicaid
TX108336202Medicaid
TX328306101Medicaid
TX108336203Medicaid
TX332123401Medicaid