Provider Demographics
NPI:1578073300
Name:GOLDTHWAITE NURSING OPERATIONS, LLC
Entity Type:Organization
Organization Name:GOLDTHWAITE NURSING OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-339-6177
Mailing Address - Street 1:306 W 7TH ST STE 430
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4902
Mailing Address - Country:US
Mailing Address - Phone:817-339-6177
Mailing Address - Fax:917-339-6178
Practice Address - Street 1:1110 RICE ST
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-4403
Practice Address - Country:US
Practice Address - Phone:325-648-2247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility