Provider Demographics
NPI:1629530423
Name:MITCHUM & WILLIAMS TENDER HEARTS GROUP
Entity Type:Organization
Organization Name:MITCHUM & WILLIAMS TENDER HEARTS GROUP
Other - Org Name:MITCHUM & WILLIAMS TENDER HEARTS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MITCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-729-0836
Mailing Address - Street 1:2111 N COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3229
Mailing Address - Country:US
Mailing Address - Phone:214-729-0836
Mailing Address - Fax:682-706-3314
Practice Address - Street 1:2111 N COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-3229
Practice Address - Country:US
Practice Address - Phone:214-729-0836
Practice Address - Fax:682-706-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health