Organization
BOUNTIFUL COMMUNITY HOME HEALTH L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TIMIERA CHANTEL CLARK S.C.O.T.A (OWNER/ADMINISTRATOR)
(817) 902-8085
Entity
Organization
Contact information
Practice address
5601 BRIDGE ST STE 300, FORT WORTH, TX 76112-2355
(817) 586-4314
(817) 489-9174
Mailing address
5601 BRIDGE STREET, 300, FORT WORTH, TX 76112-2355
(817) 586-4314
(817) 489-9174
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
TX
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
04/14/2017
Last updated
08/22/2019
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