MEDICARE: MANOR CARE OF FORT WORTH TX (NW) 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	314000000X	Skilled Nursing Facility	111031	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	:	1912940701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANOR CARE OF FORT WORTH TX (NW) LLC

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-2615
Country	:	US
Telephone Number	:	419-252-5500
Fax Number	:	877-385-9446

Provider Business Practice Location Address
First Line	:	2129 SKYLINE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-1924
Country	:	US
Telephone Number	:	817-626-1956
Fax Number	:	817-625-2515

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MARTIN D ALLEN
Credential	:
Telephone Number	:	419-252-5734

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	05/30/2017

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Directions to “MANOR CARE OF FORT WORTH TX (NW) LLC ” Practice Location

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