Provider Demographics
NPI:1699211011
Name:FPACP HUNTSVILLE LLC
Entity Type:Organization
Organization Name:FPACP HUNTSVILLE LLC
Other - Org Name:FOCUSED CARE AT HUNTSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-632-1000
Mailing Address - Street 1:1401 BALLINGER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5903
Mailing Address - Country:US
Mailing Address - Phone:817-632-1000
Mailing Address - Fax:817-632-1001
Practice Address - Street 1:1302 NOTTINGHAM ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5622
Practice Address - Country:US
Practice Address - Phone:936-295-6313
Practice Address - Fax:936-295-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility