Provider Demographics
NPI:1043927247
Name:FORT WORTH SENIOR CARE, LLC
Entity Type:Organization
Organization Name:FORT WORTH SENIOR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-883-7920
Mailing Address - Street 1:5100 RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-1553
Mailing Address - Country:US
Mailing Address - Phone:817-548-3200
Mailing Address - Fax:817-529-0768
Practice Address - Street 1:5100 RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-1553
Practice Address - Country:US
Practice Address - Phone:817-548-3200
Practice Address - Fax:817-529-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation