Provider Demographics
NPI:1770625915
Name:SENIOR CITIZEN'S ACTIVITY CENTER OF BURKBURNETT INC.
Entity type:Organization
Organization Name:SENIOR CITIZEN'S ACTIVITY CENTER OF BURKBURNETT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECROR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-569-0821
Mailing Address - Street 1:220 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-3403
Mailing Address - Country:US
Mailing Address - Phone:940-569-0821
Mailing Address - Fax:940-569-2551
Practice Address - Street 1:220 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-3403
Practice Address - Country:US
Practice Address - Phone:940-569-0821
Practice Address - Fax:940-569-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43626301332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals