MEDICARE: DALWORTH HEALTH 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

General Provider Information

NPI Number	:	1386840957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALWORTH HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	930 RIDGEBROOK RD
Second Line	:
City	:	SPARKS
State	:	MD
Zip	:	21152-9390
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 DUNCAN PERRY RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5412
Country	:	US
Telephone Number	:	817-649-3366
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAURA HOFFPAUIR
Credential	:
Telephone Number	:	817-649-3366

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	03/27/2008

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