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General NPI Number Information
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NPI Number | 1588602676
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Entity Type | Organization
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Legal Business Name | KB HEALTHCARE, INC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3825 VILLAGE CREEK RD
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City | FORT WORTH
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State | TX
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Zip | 76119-2115
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Country | US
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Telephone | 817-429-1991
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Fax | 817-536-5008
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Provider Business Mailing Address
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Address Line | 3825 VILLAGE CREEK RD
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City | FORT WORTH
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State | TX
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Zip | 76119-2115
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Country | US
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Telephone | 817-429-1991
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Fax | 817-536-5008
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KEVIN BOLDT
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Credential |
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Telephone | 817-429-1991
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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 | 112001
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License Number State | TX
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