Provider Demographics
NPI:1659688331
Name:TEXAS REHABILITATION HOSPITAL OF FORT WORTH, LLC
Entity Type:Organization
Organization Name:TEXAS REHABILITATION HOSPITAL OF FORT WORTH, LLC
Other - Org Name:TEXAS REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-320-6033
Mailing Address - Street 1:425 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-1022
Mailing Address - Country:US
Mailing Address - Phone:817-820-3400
Mailing Address - Fax:817-820-3470
Practice Address - Street 1:425 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1022
Practice Address - Country:US
Practice Address - Phone:817-820-3400
Practice Address - Fax:817-820-3470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital