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General NPI Number Information
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NPI Number | 1700892593
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Entity Type | Organization
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Legal Business Name | CENTERS FOR LONG TERM CARE ANCILLARY SERVICES INC.
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7606 PEBBLE DR BLDG 28
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City | FORT WORTH
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State | TX
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Zip | 76118-6994
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Country | US
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Telephone | 214-624-0868
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Fax | 817-595-8929
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Provider Business Mailing Address
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Address Line | 7606 PEBBLE DR BLDG 28
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City | FORT WORTH
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State | TX
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Zip | 76118-6994
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Country | US
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Telephone | 214-624-0868
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Fax | 817-358-1080
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY R TREBERT
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Credential |
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Telephone | 214-634-0868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0052443
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License Number State | TX
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