Healthcare Provider Details

I. General information

NPI: 1285045799
Provider Name (Legal Business Name): DWB PARTNER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SUMMIT AVE
FORT WORTH TX
76102-3422
US

IV. Provider business mailing address

PO BOX 672
FORT WORTH TX
76101-0672
US

V. Phone/Fax

Practice location:
  • Phone: 817-877-1616
  • Fax: 817-334-7994
Mailing address:
  • Phone: 817-877-1616
  • Fax: 817-334-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DALE WILLS BROCK
Title or Position: OWNER
Credential:
Phone: 817-877-1616