Healthcare Provider Details

I. General information

NPI: 1306239587
Provider Name (Legal Business Name): FORT WORTH SKILLED CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 VILLAGE CREEK RD
FORT WORTH TX
76119-4158
US

IV. Provider business mailing address

1019 HOLDEN ST
GLEN ROSE TX
76043-4937
US

V. Phone/Fax

Practice location:
  • Phone: 817-451-8704
  • Fax: 817-451-0048
Mailing address:
  • Phone: 254-897-1430
  • Fax: 254-897-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN K THOMAS
Title or Position: MANAGER
Credential:
Phone: 254-897-1430