Organization
FORT HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENARD A SODEK III (CONTROLLER)
(817) 678-7428
Entity
Organization
Contact information
Practice address
5833 OAKBEND TRAIL, #200, FORT WORTH, TX 76132-3900
(817) 678-7428
Mailing address
7140 OAKMONT BLVD, FORT WORTH, TX 76132-3900
(817) 678-7428
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/30/2019
Last updated
06/04/2021
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