Provider Demographics
NPI:1801369533
Name:TEXAS CONSUMER DIRECTED SERVICES, LLC
Entity Type:Organization
Organization Name:TEXAS CONSUMER DIRECTED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-999-3839
Mailing Address - Street 1:251 W LANCASTER AVE UNIT 1845
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76101-2665
Mailing Address - Country:US
Mailing Address - Phone:817-999-3839
Mailing Address - Fax:
Practice Address - Street 1:5600 EDEN RD
Practice Address - Street 2:
Practice Address - City:KENNEDALE
Practice Address - State:TX
Practice Address - Zip Code:76060-6604
Practice Address - Country:US
Practice Address - Phone:817-999-3839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care