Provider Demographics
NPI:1730704164
Name:MIGHTY MEN OF VALOR LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:MIGHTY MEN OF VALOR LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-609-5474
Mailing Address - Street 1:434 ASHLAWN DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5612
Mailing Address - Country:US
Mailing Address - Phone:817-609-5474
Mailing Address - Fax:469-672-6069
Practice Address - Street 1:434 ASHLAWN DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5612
Practice Address - Country:US
Practice Address - Phone:817-609-5474
Practice Address - Fax:469-672-6069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIGHTY MEN OF VALOR LIMITED LIABILITY COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management