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Organization
THI OF TEXAS AT FORTH WORTH LLC
Active
Organization
THI OF TEXAS AT FORTH WORTH LLC
Active
Other names
The Courtyards at Fort Worth
Organization subpart
No
Provider details
NPI number
Authorized official
LEZLIE MICHAEL (PRESIDENT)
(817) 246-4953
Entity
Organization
Contact information
Practice address
8001 WESTERN HILLS BLVD, FORT WORTH, TX 76108-3524
(817) 246-4953
Mailing address
930 RIDGEBROOK RD, SPARKS, MD 21152-9390
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001012264
MEDICAID RESPITE PROVIDER NUMBER
TX
Enumeration date
04/30/2009
Last updated
04/30/2009
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