Provider Demographics
NPI:1790201911
Name:FPACP HOGAN PARK LLC
Entity Type:Organization
Organization Name:FPACP HOGAN PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JAIMIE
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-632-1000
Mailing Address - Street 1:2501 PARKVIEW DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5841
Mailing Address - Country:US
Mailing Address - Phone:817-632-1000
Mailing Address - Fax:817-632-1001
Practice Address - Street 1:3203 SAGE ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-5711
Practice Address - Country:US
Practice Address - Phone:432-683-5403
Practice Address - Fax:432-682-5105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOCUSED POST ACUTE CARE PARTNERS II, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility