MEDICARE: 1ST PLACE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1457226466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST PLACE CARE LLC

Provider Business Mailing Address
First Line	:	6320 PURINGTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-5552
Country	:	US
Telephone Number	:	254-499-1300
Fax Number	:	254-499-1302

Provider Business Practice Location Address
First Line	:	6320 PURINGTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-5552
Country	:	US
Telephone Number	:	409-443-9026
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	EDWARD HICKS IV
Credential	:
Telephone Number	:	254-499-1300

Provider Enumeration Date	:	10/08/2025
Last Update Date	:	02/06/2026

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