MEDICARE: SUNRISE ASSISTED LIVING OF FORT WORTH

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	310400000X	Assisted Living Facility	120702	TX

General Provider Information

NPI Number	:	1275731192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE ASSISTED LIVING OF FORT WORTH

Provider Business Mailing Address
First Line	:	6151 BRYANT IRVIN ROAD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-292-2288
Fax Number	:	817-292-4668

Provider Business Practice Location Address
First Line	:	6151 BRYANT IRVIN ROAD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-292-2288
Fax Number	:	817-292-4668

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. WALTER JOSEPH ZABROUSKI III
Credential	:
Telephone Number	:	817-292-2288

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	08/22/2020

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