Organization
CCCFW, LLC
Active
Other names
Community Care Center of Fort Worth
Organization subpart
No
Provider details
NPI number
Authorized official
ROYCE FREEBOURN (CEO)
(940) 220-6440
Entity
Organization
Contact information
Practice address
900 W LEUDA ST, FORT WORTH, TX 76104-3002
(817) 332-7003
Mailing address
1714 TEASLEY LN, DENTON, TX 76205-7795
(940) 220-6440
(940) 220-6443
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00101383
—
TX
Enumeration date
07/11/2006
Last updated
08/22/2020
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