MEDICARE: QUILTED CARE--TEXAS, LIMITED PARTNERSHIP

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	000964	TX

General Provider Information

NPI Number	:	1346375631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUILTED CARE--TEXAS, LIMITED PARTNERSHIP

Provider Business Mailing Address
First Line	:	2601 TANDY AVENUE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103
Country	:	US
Telephone Number	:	817-535-1253
Fax Number	:	817-536-0177

Provider Business Practice Location Address
First Line	:	2601 TANDY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-2552
Country	:	US
Telephone Number	:	817-535-1253
Fax Number	:	817-536-0177

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	THOMAS J WITT JR.
Credential	:
Telephone Number	:	505-797-8735

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/22/2020

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