Organization
IMPATEX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE MBOCHI (MANAGER)
(817) 908-3349
Entity
Organization
Contact information
Practice address
6300 EAGLE LAKE CT, FORT WORTH, TX 76179
(817) 908-3349
Mailing address
6300 EAGLE LAKE CT, FORT WORTH, TX 76179-1645
(817) 908-3349
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
05/11/2018
Last updated
05/11/2018
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