MEDICARE: FORT HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1003305418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	7140 OAKMONT BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76132-4135
Country	:	US
Telephone Number	:	903-771-8227
Fax Number	:

Provider Business Practice Location Address
First Line	:	7140 OAKMONT BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76132-4135
Country	:	US
Telephone Number	:	903-771-8227
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	BENARD A SODEK
Credential	:
Telephone Number	:	817-678-7428

Provider Enumeration Date	:	05/02/2018
Last Update Date	:	06/04/2021

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Directions to “FORT HEALTHCARE LLC ” Practice Location

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