MEDICARE: SCP ACQUISITION PARTNERS, LTD

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1801073002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCP ACQUISITION PARTNERS, LTD

Provider Business Mailing Address
First Line	:	4244 RIVER BIRCH RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1132
Country	:	US
Telephone Number	:	817-847-5741
Fax Number	:	817-847-5721

Provider Business Practice Location Address
First Line	:	524 N PEARSON ST
Second Line	:
City	:	GODLEY
State	:	TX
Zip	:	76044-3702
Country	:	US
Telephone Number	:	817-389-3442
Fax Number	:	817-389-2354

Authorized Official
Title or Position	:	OWNER
Name	:	ALICIA KIRKPATRICK
Credential	:
Telephone Number	:	817-847-5741

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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