Provider Demographics
NPI:1962445791
Name:CATHOLIC CHARITIES OF FORT WORTH, INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF FORT WORTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-534-0814
Mailing Address - Street 1:2701 BURCHILL RD N
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-3012
Mailing Address - Country:US
Mailing Address - Phone:817-534-0814
Mailing Address - Fax:817-536-1556
Practice Address - Street 1:2701 BURCHILL RD N
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-3012
Practice Address - Country:US
Practice Address - Phone:817-534-0814
Practice Address - Fax:817-536-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N26AMedicare ID - Type Unspecified