Provider Demographics
NPI:1275731192
Name:SUNRISE ASSISTED LIVING OF FORT WORTH
Entity Type:Organization
Organization Name:SUNRISE ASSISTED LIVING OF FORT WORTH
Other - Org Name:METSUN FORT WORTH SENIOR LIVING LP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ZABROUSKI
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:817-292-2288
Mailing Address - Street 1:6151 BRYANT IRVIN ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-292-2288
Mailing Address - Fax:817-292-4668
Practice Address - Street 1:6151 BRYANT IRVIN ROAD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-292-2288
Practice Address - Fax:817-292-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120702310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility