Organization
COOLING WATERS
Active
Organization
COOLING WATERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS BENJAMIN (CEO)
(817) 534-5480
Entity
Organization
Contact information
Practice address
2320 BLUE SMOKE CT N, FORT WORTH, TX 76105-1003
(817) 534-5480
Mailing address
2320 BLUE SMOKE CT N, FORT WORTH, TX 76105-1003
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
TX
Other
Enumeration date
11/02/2013
Last updated
11/02/2013
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