Provider Demographics
NPI:1528540531
Name:ANAM RESIDENTIAL CARE
Entity Type:Organization
Organization Name:ANAM RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNEWEATHER-RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-690-4848
Mailing Address - Street 1:7112 WELSHMAN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6659
Mailing Address - Country:US
Mailing Address - Phone:817-690-4848
Mailing Address - Fax:
Practice Address - Street 1:7112 WELSHMAN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-6659
Practice Address - Country:US
Practice Address - Phone:817-690-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106726OtherPROVIDER IDENTIFICATION NUMBER
TX148822OtherALF LICENSE