Healthcare Provider Details

I. General information

NPI: 1568891174
Provider Name (Legal Business Name): SWC FORT WORTH OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 WESTERN HILLS BLVD
FT WORTH TX
76108-3524
US

IV. Provider business mailing address

8001 WESTERN HILLS BLVD
FT WORTH TX
76108-3524
US

V. Phone/Fax

Practice location:
  • Phone: 817-246-4953
  • Fax:
Mailing address:
  • Phone: 817-246-4953
  • 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: KELLE C SANTORO
Title or Position: SR DIRECTOR AR
Credential:
Phone: 832-467-5728