Provider Demographics
NPI:1750679098
Name:TARRANT COUNTY SENIOR LIVING CENTER, INC.
Entity Type:Organization
Organization Name:TARRANT COUNTY SENIOR LIVING CENTER, INC.
Other - Org Name:THE STAYTON AT MUSEUM WAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE, AUDIT & PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:NUTTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-309-7803
Mailing Address - Street 1:2501 MUSEUM WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3057
Mailing Address - Country:US
Mailing Address - Phone:817-332-3332
Mailing Address - Fax:
Practice Address - Street 1:2501 MUSEUM WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3057
Practice Address - Country:US
Practice Address - Phone:817-332-3332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility