Provider Demographics
NPI:1932330255
Name:S SHELBY COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:S SHELBY COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:SHELBY & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHALITHA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-729-1150
Mailing Address - Street 1:PO BOX 19153
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-1153
Mailing Address - Country:US
Mailing Address - Phone:817-729-1150
Mailing Address - Fax:817-451-2020
Practice Address - Street 1:3829 E LOOP 820 S STE 210
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-4337
Practice Address - Country:US
Practice Address - Phone:817-729-1150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
324500000X
TX18616798343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle