MEDICARE: HOME OF CHAMPIONS

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1245882588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME OF CHAMPIONS

Provider Business Mailing Address
First Line	:	7816 WHITNEY LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-6168
Country	:	US
Telephone Number	:	817-899-3132
Fax Number	:	888-588-4001

Provider Business Practice Location Address
First Line	:	7816 WHITNEY LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-6168
Country	:	US
Telephone Number	:	817-899-3132
Fax Number	:	888-588-4001

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JANE HOUSTON
Credential	:
Telephone Number	:	817-899-3132

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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Directions to “HOME OF CHAMPIONS ” Practice Location

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