Healthcare Provider Details

I. General information

NPI: 1174604813
Provider Name (Legal Business Name): JAMES L WEST PRESBYTERIAN SPECIAL CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUMMIT AVE
FORT WORTH TX
76102-3425
US

IV. Provider business mailing address

1111 SUMMIT AVE
FORT WORTH TX
76102-3425
US

V. Phone/Fax

Practice location:
  • Phone: 817-877-1199
  • Fax: 817-877-1414
Mailing address:
  • Phone: 817-877-1199
  • Fax: 817-877-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000239
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number000239
License Number StateTX

VIII. Authorized Official

Name: CHERYL HARDING
Title or Position: CEO
Credential:
Phone: 817-877-1199