Provider Demographics
NPI:1164646287
Name:JULIETTE FOWLER HOMES, INC.
Entity Type:Organization
Organization Name:JULIETTE FOWLER HOMES, INC.
Other - Org Name:JULIETTE FOWLER COMMUNITIES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:214-827-0813
Mailing Address - Street 1:1234 ABRAMS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4850
Mailing Address - Country:US
Mailing Address - Phone:214-827-0813
Mailing Address - Fax:214-827-7021
Practice Address - Street 1:1260 ABRAMS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4850
Practice Address - Country:US
Practice Address - Phone:214-827-0813
Practice Address - Fax:214-827-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118191314000000X
TX134837314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000460901Medicaid
TX000460901Medicaid