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General NPI Number Information
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NPI Number | 1811453079
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Entity Type | Organization
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Legal Business Name | SSC FORT WORTH NURSING & REHABILITATION CENTER OPERATING COMPANY LLC
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 4825 WELLESLEY AVE
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City | FORT WORTH
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State | TX
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Zip | 76107-6148
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Country | US
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Telephone | 817-732-4714
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Fax | 817-735-4118
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Provider Business Mailing Address
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Address Line | 5300 W SAM HOUSTON PKWY N STE 100
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City | HOUSTON
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State | TX
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Zip | 77041-5162
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Country | US
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Telephone | 832-467-5728
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Fax | 832-467-8500
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Authorized Official
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Title or Position | SR DIRECTOR A/R
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Name | KELLE C SANTORO
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Credential |
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Telephone | 832-467-5728
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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 |
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