Provider Demographics
NPI:1134697030
Name:A SERVICE WITH RESPECT
Entity Type:Organization
Organization Name:A SERVICE WITH RESPECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAHIRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:817-919-1603
Mailing Address - Street 1:2412 JEFFERSON COURT LN APT 1630
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-4247
Mailing Address - Country:US
Mailing Address - Phone:817-919-1603
Mailing Address - Fax:682-252-7137
Practice Address - Street 1:2080 N HWY 360 STE 220
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1451
Practice Address - Country:US
Practice Address - Phone:817-919-1603
Practice Address - Fax:682-252-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care