Provider Demographics
NPI:1376751404
Name:EASTER SEALS NORTH TEXAS INC.
Entity Type:Organization
Organization Name:EASTER SEALS NORTH TEXAS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-332-7171
Mailing Address - Street 1:6900 ANDERSON BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-3030
Mailing Address - Country:US
Mailing Address - Phone:817-332-7171
Mailing Address - Fax:817-665-0878
Practice Address - Street 1:6900 ANDERSON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-3030
Practice Address - Country:US
Practice Address - Phone:817-332-7171
Practice Address - Fax:817-665-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
TX010383251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health