Provider Demographics
NPI:1942826318
Name:KING-FULTON, LACINDER ROSEANN (PROGRAM DIRECTOR)
Entity Type:Individual
Prefix:MRS
First Name:LACINDER
Middle Name:ROSEANN
Last Name:KING-FULTON
Suffix:
Gender:F
Credentials:PROGRAM DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SWITCHGRASS LN
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4341
Mailing Address - Country:US
Mailing Address - Phone:469-478-0573
Mailing Address - Fax:
Practice Address - Street 1:1205 SWITCHGRASS LN
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4341
Practice Address - Country:US
Practice Address - Phone:469-478-0573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No372600000XNursing Service Related ProvidersAdult Companion