Healthcare Provider Details

I. General information

NPI: 1871045708
Provider Name (Legal Business Name): CNS - F.W., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 HARRIS PARKWAY
FORT WORTH TX
76132
US

IV. Provider business mailing address

5215 ASHE RD
BAKERSFIELD CA
93313-2069
US

V. Phone/Fax

Practice location:
  • Phone: 661-872-3408
  • Fax:
Mailing address:
  • Phone: 661-872-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES W SANDERS
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 661-872-3408