Organization
MILESTONE GERIATRIC DAY CARE, INC
Active
Other names
Milestone Behavior Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY LUEEL IRVING (DIRECTOR)
(817) 429-2290
Entity
Organization
Contact information
Practice address
2516 OAKLAND BLVD, SUITE 3, FORT WORTH, TX 76103-3201
(817) 429-2290
(814) 492-9098
Mailing address
2516 OAKLAND BLVD, SUITE 3, FORT WORTH, TX 76103-3203
(817) 429-2290
(814) 492-9098
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153822502
—
TX
Enumeration date
07/11/2006
Last updated
05/20/2008
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