Provider Demographics
NPI:1376949677
Name:FOWLER CHRISTIAN APARTMENTS
Entity Type:Organization
Organization Name:FOWLER CHRISTIAN APARTMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-515-1360
Mailing Address - Street 1:105 JULIETTE FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4876
Mailing Address - Country:US
Mailing Address - Phone:214-821-4061
Mailing Address - Fax:214-515-1337
Practice Address - Street 1:105 JULIETTE FOWLER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4876
Practice Address - Country:US
Practice Address - Phone:214-821-4061
Practice Address - Fax:214-515-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101878310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001015510Medicaid