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NPI Code Detail

MEDICARE: CASABLANCA ASSISTED LIVING AND MEMORY CARE

MEDICARE: CASABLANCA ASSISTED LIVING AND MEMORY CARE
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
1251B00000XCase Management Agency000671TX

General Provider Information

NPI Number : 1013334721
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASABLANCA ASSISTED LIVING AND MEMORY CARE
Provider Business Mailing Address
First Line : 6617 DAN DANCIGER RD
Second Line :
City : FT WORTH
State : TX
Zip : 76133-4905
Country : US
Telephone Number : 817-292-0925
Fax Number :
Provider Business Practice Location Address
First Line : 6617 DAN DANCIGER RD
Second Line :
City : FT WORTH
State : TX
Zip : 76133-4905
Country : US
Telephone Number : 817-292-0925
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : LOU LOSANES
Credential : PHYSICAL THERAPIST
Telephone Number : 972-816-9663
Provider Enumeration Date : 03/20/2014
Last Update Date : 03/20/2014

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Directions to “CASABLANCA ASSISTED LIVING AND MEMORY CARE ” Practice Location

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