Provider Demographics
NPI:1396921656
Name:FABOS COMMUNITY INTERSECTION, LLC
Entity type:Organization
Organization Name:FABOS COMMUNITY INTERSECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING
Authorized Official - Prefix:MS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:FUNKE
Authorized Official - Last Name:AKINGBADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-987-7634
Mailing Address - Street 1:PO BOX 5133
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-5133
Mailing Address - Country:US
Mailing Address - Phone:817-987-7634
Mailing Address - Fax:
Practice Address - Street 1:924 MARION AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-6537
Practice Address - Country:US
Practice Address - Phone:817-987-7634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities