Healthcare Provider Details

I. General information

NPI: 1588725592
Provider Name (Legal Business Name): FWM HEALTHCARE, LLC DBA FT. WORTH MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 E BERRY ST
FT WORTH TX
76105-4314
US

IV. Provider business mailing address

2712 HURSTVIEW DR
HURST TX
76054-2402
US

V. Phone/Fax

Practice location:
  • Phone: 817-531-3707
  • Fax:
Mailing address:
  • Phone: 817-514-2203
  • Fax: 817-281-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: AL SUTTON
Title or Position: PRESIDENT
Credential:
Phone: 817-514-2203