MEDICARE: REMARKABLE HEALTHCARE OF FORT WORTH, LP

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		TX
2	314000000X	Skilled Nursing Facility	139958	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	:	1386949220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REMARKABLE HEALTHCARE OF FORT WORTH, LP

Provider Business Mailing Address
First Line	:	PO BOX 164966
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-4966
Country	:	US
Telephone Number	:	817-847-1860
Fax Number	:	817-847-0685

Provider Business Practice Location Address
First Line	:	6649 NORTH RIVERSIDE DRIVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137
Country	:	US
Telephone Number	:	817-847-1860
Fax Number	:	817-847-0685

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	LAURIE BETH MCPIKE
Credential	:
Telephone Number	:	817-308-6226

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	12/02/2016

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