MEDICARE: FORT WORTH SKILLED CARE, 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	314000000X	Skilled Nursing Facility

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306239587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT WORTH SKILLED CARE, LLC

Provider Business Mailing Address
First Line	:	1019 HOLDEN ST
Second Line	:
City	:	GLEN ROSE
State	:	TX
Zip	:	76043-4937
Country	:	US
Telephone Number	:	254-897-1430
Fax Number	:	254-897-1486

Provider Business Practice Location Address
First Line	:	4515 VILLAGE CREEK RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-4158
Country	:	US
Telephone Number	:	817-451-8704
Fax Number	:	817-451-0048

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. BRIAN K THOMAS
Credential	:
Telephone Number	:	254-897-1430

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	04/09/2025

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