Provider Demographics
NPI:1104163732
Name:RICIA DANIELS
Entity type:Organization
Organization Name:RICIA DANIELS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-436-1894
Mailing Address - Street 1:1617 PARK PLACE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1300
Mailing Address - Country:US
Mailing Address - Phone:903-436-1894
Mailing Address - Fax:972-502-9717
Practice Address - Street 1:1617 PARK PLACE AVE STE 110
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1300
Practice Address - Country:US
Practice Address - Phone:903-436-1894
Practice Address - Fax:972-502-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHHS0000042000022Medicaid
TXHHS000004300004Medicaid
TXHHS4100013Medicaid
TXHHS00000400003Medicaid
TXHHS00000400005Medicaid
TXHHS000004300001Medicaid
TXHHS000004300002Medicaid
TXHHS000000400002Medicaid
TXHHS0000042000020Medicaid