MEDICARE: REGENCY HOSPITAL OF FORT WORTH, LLLP

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	282E00000X	Long Term Care Hospital	008392	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205884491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY HOSPITAL OF FORT WORTH, LLLP

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:	LEGAL DPT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	6801 OAKMONT BOULEVARD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	770-754-5232
Fax Number	:	770-776-5321

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL TARVIN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/31/2010

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