MEDICARE: HALTOM OPERATIONS, 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	5090	TX

General Provider Information

NPI Number	:	1700802873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALTOM OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5751
Fax Number	:	423-339-8342

Provider Business Practice Location Address
First Line	:	2936 MARKUM DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76117-4001
Country	:	US
Telephone Number	:	817-831-0545
Fax Number	:	817-831-3051

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	CINDY S CROSS
Credential	:
Telephone Number	:	423-473-5867

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/11/2007

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Directions to “HALTOM OPERATIONS, LLC ” Practice Location

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