MEDICARE: FWM HEALTHCARE, LLC DBA FT. WORTH MANOR

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	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1588725592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FWM HEALTHCARE, LLC DBA FT. WORTH MANOR

Provider Business Mailing Address
First Line	:	2712 HURSTVIEW DR
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76054-2402
Country	:	US
Telephone Number	:	817-514-2203
Fax Number	:	817-281-6717

Provider Business Practice Location Address
First Line	:	4900 E BERRY ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76105-4314
Country	:	US
Telephone Number	:	817-531-3707
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AL SUTTON
Credential	:
Telephone Number	:	817-514-2203

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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