MEDICARE: PERFORMANCE CARE CENTERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245662675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE CARE CENTERS LLC

Provider Business Mailing Address
First Line	:	7021 BRYANT IRVIN ROAD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3834
Country	:	US
Telephone Number	:	817-361-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	7021 BRYANT IRVIN ROAD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-535-3447
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEZLIE MICHAEL
Credential	:
Telephone Number	:	817-361-1400

Provider Enumeration Date	:	08/08/2013
Last Update Date	:	02/07/2014

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Directions to “PERFORMANCE CARE CENTERS LLC ” Practice Location

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