Provider Demographics
NPI:1447052691
Name:OUR LOVING ABODE, INC
Entity type:Organization
Organization Name:OUR LOVING ABODE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINEOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-714-7069
Mailing Address - Street 1:5304 GREENSHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-8720
Mailing Address - Country:US
Mailing Address - Phone:817-714-7069
Mailing Address - Fax:
Practice Address - Street 1:5304 GREENSHAVEN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-8720
Practice Address - Country:US
Practice Address - Phone:817-714-7069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle