MEDICARE: JAMES L WEST PRESBYTERIAN SPECIAL CARE CENTER

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1750091591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES L WEST PRESBYTERIAN SPECIAL CARE CENTER

Provider Business Mailing Address
First Line	:	1111 SUMMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3425
Country	:	US
Telephone Number	:	817-877-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	6050 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4102
Country	:	US
Telephone Number	:	817-877-1199
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHERYL HARDING
Credential	:	PHD
Telephone Number	:	817-877-1199

Provider Enumeration Date	:	12/02/2022
Last Update Date	:	12/02/2022

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