Provider Demographics
NPI:1235793472
Name:A SERVANT'S HEART-TEXAS LLC
Entity Type:Organization
Organization Name:A SERVANT'S HEART-TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-714-9900
Mailing Address - Street 1:207 FAIRCREST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-4027
Mailing Address - Country:US
Mailing Address - Phone:817-793-2088
Mailing Address - Fax:
Practice Address - Street 1:207 FAIRCREST DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-4027
Practice Address - Country:US
Practice Address - Phone:682-241-0309
Practice Address - Fax:800-719-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care
No333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX05Medicaid