Provider Demographics
NPI:1124282231
Name:HIBISCUS RESIDENTIAL CARE AHAOMES
Entity type:Organization
Organization Name:HIBISCUS RESIDENTIAL CARE AHAOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOCTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-719-3022
Mailing Address - Street 1:341 MCMURTRY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4481
Mailing Address - Country:US
Mailing Address - Phone:817-719-3022
Mailing Address - Fax:817-719-4128
Practice Address - Street 1:341 MCMURTRY DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4481
Practice Address - Country:US
Practice Address - Phone:817-719-3022
Practice Address - Fax:817-719-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124051320700000X, 320800000X, 332BC3200X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment