MEDICARE: 2601 TANDY ABL I OPERATIONS, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1578295127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2601 TANDY ABL I OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	2601 TANDY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-2552
Country	:	US
Telephone Number	:	817-840-2961
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	:	CFO
Name	:	MR. JASON E QUICK
Credential	:
Telephone Number	:	817-475-3521

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	08/10/2023

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