# CHARLESTON DFW OPERATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DFW Nursing & Rehab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851729560
- **Authorized official:** KENDALL A BROUSSARD (MANAGING MEMBER)
- **Authorized official phone:** (337) 439-6600

## Contact information

- **Practice address:** 900 W LEUDA ST, FORT WORTH, TX 76104-3002
- **Practice address phone:** (337) 439-6600
- **Practice address fax:** (337) 439-6647
- **Mailing address:** 127 W BROAD ST STE 800, LAKE CHARLES, LA 70601-4297
- **Mailing address phone:** (337) 439-6600
- **Mailing address fax:** (337) 439-6647

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 136289 | TX | Yes |

## Other

- **Enumeration date:** 10/16/2013
- **Last updated:** 12/11/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001025543 | — | TX |
| 05 | — | 004002 | — | TX |
| 05 | — | 4002 | — | TX |