Organization
SELF RICHARD DBA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD RAY BAKER SR. (HOME HEALTH NURSE AIDE)
(817) 304-8292
Entity
Organization
Contact information
Practice address
6701 CALMONT AVE APT 101, FORT WORTH, TX 76116-4239
(817) 304-2892
(817) 246-4764
Mailing address
6701 CALMONT AVE APT 101, FORT WORTH, TX 76116-4239
(817) 304-2892
(817) 246-4764
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
09332825
TX
347C00000X
Private Vehicle
Primary
09332825
TX
Other
Enumeration date
08/17/2008
Last updated
08/17/2008
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