Provider Demographics
NPI:1992979512
Name:T-FORE
Entity type:Organization
Organization Name:T-FORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLOTA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR-LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MA , CCJP
Authorized Official - Phone:409-789-4892
Mailing Address - Street 1:660 WARSAW ST
Mailing Address - Street 2:
Mailing Address - City:BAYOU VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:77563-2606
Mailing Address - Country:US
Mailing Address - Phone:409-789-4892
Mailing Address - Fax:831-305-9133
Practice Address - Street 1:660 WARSAW ST
Practice Address - Street 2:
Practice Address - City:BAYOU VISTA
Practice Address - State:TX
Practice Address - Zip Code:77563-2606
Practice Address - Country:US
Practice Address - Phone:409-789-4892
Practice Address - Fax:831-305-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health