| Organization Name: | SELF RICHARD DBA |
| NPI Number: | 1003062472 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD RAY BAKER (HOME HEALTH NURSE AIDE) |
| Mailing Address: | 6701 Calmont Ave Apt 101 Fort Worth |
| State: | TX US |
| Postal Code: | 761164239 |
| Phone Number: | 8173042892 |
| Fax Number: | 8172464764 |
| NPI Enumeration Date: | 08/17/2008 |
| NPI Last Update Date: | 08/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | 09332825 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |