# FORT WORTH NURSING & REHABILITATION CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053309575
- **Authorized official:** MR. DICK STEBBINS CPA (PRESIDENT OF GENERAL PARTNER)
- **Authorized official phone:** (903) 757-5360

## Contact information

- **Practice address:** 1000 6TH AVE, FORT WORTH, TX 76104-2808
- **Practice address phone:** (817) 336-2586
- **Practice address fax:** (817) 336-6620
- **Mailing address:** 600 E WHALEY ST, LONGVIEW, TX 75601-6525
- **Mailing address phone:** (903) 757-5360
- **Mailing address fax:** (903) 753-8621

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 109618 | TX | Yes |
| 332BN1400X | Nursing Facility Supplies (DME) | 109618 | TX | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | 109618 | TX | — |

## Other

- **Enumeration date:** 10/10/2005
- **Last updated:** 06/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000400403 | — | TX |
| 05 | — | 094414201 | — | TX |
| 05 | — | 094414202 | — | TX |
| 05 | — | HO4554608 | — | TX |