Provider Demographics
NPI:1245430552
Name:DOROTHY J. HARROD
Entity Type:Organization
Organization Name:DOROTHY J. HARROD
Other - Org Name:TLC PROFESSIONAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-465-7730
Mailing Address - Street 1:126 W MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-6363
Mailing Address - Country:US
Mailing Address - Phone:903-465-7730
Mailing Address - Fax:903-465-4248
Practice Address - Street 1:126 W MONTEREY ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75021-6363
Practice Address - Country:US
Practice Address - Phone:903-465-7730
Practice Address - Fax:903-465-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003104251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187201202Medicaid