Organization
SOUL FOUNDATION INC
Active
Other names
Soul Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
RICK SAGA (PRESIDENT)
(901) 501-7242
Entity
Organization
Contact information
Practice address
1111 5TH AVE, FORT WORTH, TX 76104-4302
(702) 722-7177
Mailing address
4940 N TARRANT PKWY, FORT WORTH, TX 76244-5433
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
122300000X
Dentist
—
—
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
804566904
FILE NUMBER SECRETARY OF STATE
TX
Enumeration date
11/02/2022
Last updated
11/02/2022
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