Provider Demographics
NPI:1386119139
Name:TEXAS BOY LLC
Entity type:Organization
Organization Name:TEXAS BOY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KINCEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:817-983-0048
Mailing Address - Street 1:2501 AVENUE J STE 115
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6182
Mailing Address - Country:US
Mailing Address - Phone:817-500-5914
Mailing Address - Fax:817-382-8656
Practice Address - Street 1:2501 AVENUE J STE 115
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6182
Practice Address - Country:US
Practice Address - Phone:817-500-5914
Practice Address - Fax:817-382-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX422744901Medicaid