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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