Provider Demographics
NPI:1932308947
Name:MY HEALTH MY RESOURCES OF TARRANT COUNTY
Entity Type:Organization
Organization Name:MY HEALTH MY RESOURCES OF TARRANT COUNTY
Other - Org Name:MHMRTC TARRANT CLASS CONTRACT
Other - Org Type:Other Name
Authorized Official - Title/Position:ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-569-5235
Mailing Address - Street 1:PO BOX 2603
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113-2603
Mailing Address - Country:US
Mailing Address - Phone:817-569-4396
Mailing Address - Fax:817-569-4517
Practice Address - Street 1:1300 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-8113
Practice Address - Country:US
Practice Address - Phone:817-569-4396
Practice Address - Fax:817-569-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014518Medicaid