# CCCFW, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Community Care Center of Fort Worth
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356376321
- **Authorized official:** ROYCE FREEBOURN (CEO)
- **Authorized official phone:** (940) 220-6440

## Contact information

- **Practice address:** 900 W LEUDA ST, FORT WORTH, TX 76104-3002
- **Practice address phone:** (817) 332-7003
- **Mailing address:** 1714 TEASLEY LN, DENTON, TX 76205-7795
- **Mailing address phone:** (940) 220-6440
- **Mailing address fax:** (940) 220-6443

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | TX | Yes |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00101383 | — | TX |