Provider Demographics
NPI:1568891174
Name:SWC FORT WORTH OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:SWC FORT WORTH OPERATING COMPANY LLC
Other - Org Name:THE COURTYARDS AT FORT WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR AR
Authorized Official - Prefix:
Authorized Official - First Name:KELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-467-5728
Mailing Address - Street 1:8001 WESTERN HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-3524
Mailing Address - Country:US
Mailing Address - Phone:817-246-4953
Mailing Address - Fax:
Practice Address - Street 1:8001 WESTERN HILLS BLVD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-3524
Practice Address - Country:US
Practice Address - Phone:817-246-4953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001026787Medicaid
TX001026787Medicaid