Healthcare Provider Details

I. General information

NPI: 1194324368
Provider Name (Legal Business Name): LAKE WORTH I ENTERPRISES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 MARINA DR
LAKE WORTH TX
76135-2835
US

IV. Provider business mailing address

4150 INTERNATIONAL PLZ STE 600
FORT WORTH TX
76109-4831
US

V. Phone/Fax

Practice location:
  • Phone: 817-237-7231
  • Fax: 817-237-5086
Mailing address:
  • Phone: 817-348-8959
  • 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: LINDA HUGGINS
Title or Position: VP OF ACCOUNTS RECEIVABLE
Credential:
Phone: 817-348-8959