Healthcare Provider Details

I. General information

NPI: 1689507683
Provider Name (Legal Business Name): 4515 VILLAGE CREEK RD OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 VILLAGE CREEK RD
FORT WORTH TX
76119-4158
US

IV. Provider business mailing address

4515 VILLAGE CREEK RD
FORT WORTH TX
76119-4158
US

V. Phone/Fax

Practice location:
  • Phone: 817-451-8704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: NOCHUM FREUND
Title or Position: CEO
Credential:
Phone: 732-719-5098