Provider Demographics
NPI:1194104752
Name:1 HOUSE OF ANGELS.
Entity type:Organization
Organization Name:1 HOUSE OF ANGELS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANESHA
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:817-228-5438
Mailing Address - Street 1:7507 CRESSWELL DR.
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001
Mailing Address - Country:US
Mailing Address - Phone:817-228-5438
Mailing Address - Fax:
Practice Address - Street 1:7507 CRESSWELL DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-5919
Practice Address - Country:US
Practice Address - Phone:817-228-5438
Practice Address - Fax:817-538-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226234320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities