# WEDGEWOOD SNF LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wedgewood Nursing Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174857676
- **Authorized official:** ZEVI KOHN (CFO)
- **Authorized official phone:** (718) 412-3522

## Contact information

- **Practice address:** 6621 DAN DANCIGER RD, FORT WORTH, TX 76133-4905
- **Practice address phone:** (817) 292-6330
- **Mailing address:** 2225 E RANDOL MILL RD, SUITE 630, ARLINGTON, TX 76011-6315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | TX | Yes |
| 332BN1400X | Nursing Facility Supplies (DME) | — | TX | — |

## Other

- **Enumeration date:** 09/30/2009
- **Last updated:** 10/21/2009