Provider Demographics
NPI:1790163228
Name:BANC MANAGEMENT & SERVICES
Entity Type:Organization
Organization Name:BANC MANAGEMENT & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTIONETTE
Authorized Official - Middle Name:FELICIA
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:817-492-5948
Mailing Address - Street 1:10300 TAMMARON TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-6602
Mailing Address - Country:US
Mailing Address - Phone:817-492-5948
Mailing Address - Fax:817-423-9661
Practice Address - Street 1:10300 TAMMARON TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-6602
Practice Address - Country:US
Practice Address - Phone:817-492-5948
Practice Address - Fax:817-423-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home