MEDICARE: SWC FORT WORTH OPERATING COMPANY 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	:	1568891174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWC FORT WORTH OPERATING COMPANY LLC

Provider Business Mailing Address
First Line	:	8001 WESTERN HILLS BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76108-3524
Country	:	US
Telephone Number	:	817-246-4953
Fax Number	:

Provider Business Practice Location Address
First Line	:	8001 WESTERN HILLS BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76108-3524
Country	:	US
Telephone Number	:	817-246-4953
Fax Number	:

Authorized Official
Title or Position	:	SR DIRECTOR AR
Name	:	KELLE C SANTORO
Credential	:
Telephone Number	:	832-467-5728

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	08/04/2015

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