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General NPI Number Information
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NPI Number | 1356376321
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Entity Type | Organization
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Legal Business Name | CCCFW, LLC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 W LEUDA ST
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City | FORT WORTH
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State | TX
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Zip | 76104-3002
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Country | US
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Telephone | 817-332-7003
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Fax |
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Provider Business Mailing Address
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Address Line | 1714 TEASLEY LN
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City | DENTON
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State | TX
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Zip | 76205-7795
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Country | US
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Telephone | 940-220-6440
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Fax | 940-220-6443
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Authorized Official
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Title or Position | CEO
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Name | ROYCE FREEBOURN
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Credential |
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Telephone | 940-220-6440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | TX
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