Organization
PERFORMANCE CARE CENTERS LLC
Active
Other names
Mira Vista Court
Organization subpart
No
Provider details
NPI number
Authorized official
LEZLIE MICHAEL (PRESIDENT)
(817) 361-1400
Entity
Organization
Contact information
Practice address
7021 BRYANT IRVIN ROAD, FORT WORTH, TX 76132
(817) 535-3447
Mailing address
7021 BRYANT IRVIN ROAD, FORT WORTH, TX 76132-3834
(817) 361-1400
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001025484
—
TX
Enumeration date
08/08/2013
Last updated
02/07/2014
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