Basic Information
| Provider Information | |||||||||
| NPI: | 1578295127 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 2601 TANDY ABL I OPERATIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 TANDY AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761032552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175351253 | ||||||||
| FaxNumber: | 8175360177 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 TANDY AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761032552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175351253 | ||||||||
| FaxNumber: | 8175360177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2022 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZAMORA | ||||||||
| AuthorizedOfficialFirstName: | EVA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARALEGAL | ||||||||
| AuthorizedOfficialTelephone: | 8063790399 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.