Provider Demographics
NPI:1013042746
Name:ALL CHURCH HOME FOR CHILDREN
Entity Type:Organization
Organization Name:ALL CHURCH HOME FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALETEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-886-7109
Mailing Address - Street 1:3712 WICHITA ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-2866
Mailing Address - Country:US
Mailing Address - Phone:817-335-4041
Mailing Address - Fax:217-887-2735
Practice Address - Street 1:3712 WICHITA ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-2866
Practice Address - Country:US
Practice Address - Phone:817-335-4041
Practice Address - Fax:217-887-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1459711-01Medicaid