Provider Demographics
NPI:1871896217
Name:INNER CITY COMMUNITY SERVICES OF TARRANT COUNTY
Entity type:Organization
Organization Name:INNER CITY COMMUNITY SERVICES OF TARRANT COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-607-8184
Mailing Address - Street 1:4925 RICKEE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-3651
Mailing Address - Country:US
Mailing Address - Phone:817-607-8184
Mailing Address - Fax:208-888-2476
Practice Address - Street 1:4925 RICKEE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-3651
Practice Address - Country:US
Practice Address - Phone:817-607-8184
Practice Address - Fax:208-888-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty