Provider Demographics
NPI:1437201910
Name:DONNA L FORNS
Entity Type:Organization
Organization Name:DONNA L FORNS
Other - Org Name:QUALITY LIVING THROUGH CHOICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FORNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-551-3733
Mailing Address - Street 1:PO BOX 40683
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-0683
Mailing Address - Country:US
Mailing Address - Phone:817-551-3733
Mailing Address - Fax:817-551-3799
Practice Address - Street 1:3126 SE LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-1031
Practice Address - Country:US
Practice Address - Phone:817-551-3733
Practice Address - Fax:817-551-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16000302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization