Provider Demographics
NPI:1285843227
Name:MAURICE BARNETT GERIATRIC WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:MAURICE BARNETT GERIATRIC WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN,MPA
Authorized Official - Phone:972-941-7335
Mailing Address - Street 1:401 W 16TH ST STE 600
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7005
Mailing Address - Country:US
Mailing Address - Phone:972-941-7335
Mailing Address - Fax:972-516-4870
Practice Address - Street 1:401 W 16TH ST STE 600
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7005
Practice Address - Country:US
Practice Address - Phone:972-941-7335
Practice Address - Fax:972-516-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPHO348Medicare ID - Type Unspecified