Provider Demographics
NPI:1225242621
Name:MY HEALTH MY RESOURCES OF TARRANT COUNTY
Entity Type:Organization
Organization Name:MY HEALTH MY RESOURCES OF TARRANT COUNTY
Other - Org Name:MHMR OF TARRANT COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-569-4300
Mailing Address - Street 1:PO BOX 2603
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113-2603
Mailing Address - Country:US
Mailing Address - Phone:817-569-4300
Mailing Address - Fax:817-569-4517
Practice Address - Street 1:5325 LOVELL AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5227
Practice Address - Country:US
Practice Address - Phone:817-569-4396
Practice Address - Fax:817-569-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001029084Medicaid
TX001019618Medicaid
TX000737101Medicaid