Provider Demographics
NPI:1427405083
Name:ABLECARE GROUP HOME LLC
Entity Type:Organization
Organization Name:ABLECARE GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:817-443-8775
Mailing Address - Street 1:2533 MILL SPRINGS PASS
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2615
Mailing Address - Country:US
Mailing Address - Phone:817-443-8775
Mailing Address - Fax:
Practice Address - Street 1:2533 MILL SPRINGS PASS
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2615
Practice Address - Country:US
Practice Address - Phone:817-443-8775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32090000X320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities