Provider Demographics
NPI:1417215989
Name:NORTH TEXAS AREA COMMUNITY HEALTH CENTERS, INC.
Entity type:Organization
Organization Name:NORTH TEXAS AREA COMMUNITY HEALTH CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARCADIO
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-378-0855
Mailing Address - Street 1:2100 N MAIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-8570
Mailing Address - Country:US
Mailing Address - Phone:817-378-0855
Mailing Address - Fax:817-378-0861
Practice Address - Street 1:2000 S FM 51
Practice Address - Street 2:SUITE D
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3702
Practice Address - Country:US
Practice Address - Phone:940-393-0100
Practice Address - Fax:940-393-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2015-01-12
Deactivation Date:2013-10-23
Deactivation Code:
Reactivation Date:2015-01-12
Provider Licenses
StateLicense IDTaxonomies
TX261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)