MEDICARE: HEART2HEART REHAB HEALTH CARE AGENCY

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	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1417394412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART2HEART REHAB HEALTH CARE AGENCY

Provider Business Mailing Address
First Line	:	7940 HIDDEN BROOK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-3636
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7940 HIDDEN BROOK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-3636
Country	:	US
Telephone Number	:	817-673-3758
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	KOBE LEWIS
Credential	:
Telephone Number	:	248-929-1043

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	05/30/2013

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