Provider Demographics
NPI:1740477280
Name:JULIETTE FOWLER HOMES, INC.
Entity type:Organization
Organization Name:JULIETTE FOWLER HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PORTER.
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:214-827-0813
Mailing Address - Street 1:1234 ABRAMS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4850
Mailing Address - Country:US
Mailing Address - Phone:214-827-0813
Mailing Address - Fax:214-827-7021
Practice Address - Street 1:1234 ABRAMS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4850
Practice Address - Country:US
Practice Address - Phone:214-827-0813
Practice Address - Fax:214-827-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66955261QM0801X, 261QM0850X, 261QM0855X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health