MEDICARE: LAKE WORTH INVESTMENTS INC.

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	110621	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	:	1437134111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE WORTH INVESTMENTS INC.

Provider Business Mailing Address
First Line	:	4220 WELLS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2712
Country	:	US
Telephone Number	:	817-237-6101
Fax Number	:	817-237-4864

Provider Business Practice Location Address
First Line	:	4220 WELLS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2712
Country	:	US
Telephone Number	:	817-237-6101
Fax Number	:	817-237-4864

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. WILL CASSTEVENS
Credential	:
Telephone Number	:	817-237-6101

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/17/2019

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