Organization
CENTERS FOR LONG TERM CARE ANCILLARY SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY R TREBERT (OWNER)
(214) 634-0868
Entity
Organization
Contact information
Practice address
7606 PEBBLE DR, BLDG 28, FORT WORTH, TX 76118-6994
(214) 624-0868
(817) 595-8929
Mailing address
7606 PEBBLE DR, BLDG 28, FORT WORTH, TX 76118-6994
(214) 624-0868
(817) 358-1080
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0052443
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00939232A
—
GA
05
—
0548974
—
IA
05
—
75033020
—
NM
Enumeration date
07/31/2006
Last updated
08/22/2020
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