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PROVIDENCE HOME

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SAAGHE MMBI FOGWE (OWNER/MANAGER)
(817) 715-0236
Entity
Organization

Contact information

Practice address
8108 MODESTO DR, ARLINGTON, TX 76001-8545
(817) 715-0236
Mailing address
8108 MODESTO DR, ARLINGTON, TX 76001-8545
(817) 715-0236

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary

Other

Enumeration date
05/20/2010
Last updated
05/20/2010
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