Organization
AIDS OUTREACH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELLISAND LE ROY (ASSOCIATE EXECUTIVE DIRECTOR)
(817) 335-1994
Entity
Organization
Contact information
Practice address
400 NORTH BEACH STREET, FORT WORTH, TX 76111
(817) 335-1994
(817) 335-3617
Mailing address
400 NORTH BEACH STREET, FORT WORTH, TX 76111
(817) 335-1994
(817) 335-3617
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
NA
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109329601
—
TX
05
—
109329602
—
TX
01
—
TXB112740
MEDICARE PTAN
TX
Enumeration date
02/28/2007
Last updated
03/30/2015
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