Provider Demographics
NPI:1790251593
Name:JONES, CHRISTOPHER (LICENSE PROVIDER)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:LICENSE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 GREENBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3037
Mailing Address - Country:US
Mailing Address - Phone:817-991-2768
Mailing Address - Fax:817-534-5771
Practice Address - Street 1:6405 GREENBRIAR LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3037
Practice Address - Country:US
Practice Address - Phone:817-991-2768
Practice Address - Fax:817-534-5771
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146250310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477832681OtherNPI
TX453547300OtherTAX ID
TX310400000XOtherTAXONOMY