MEDICARE: TIMELESS CARE HOMES 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	:	1669314803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMELESS CARE HOMES LLC

Provider Business Mailing Address
First Line	:	1717 JACQUELINE CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-3958
Country	:	US
Telephone Number	:	817-670-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 JACQUELINE CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-3958
Country	:	US
Telephone Number	:	817-670-2273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TANNER LANDRY
Credential	:
Telephone Number	:	817-670-2273

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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