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Organization

CHARLESTON DFW OPERATIONS LLC

Active
Other names
DFW Nursing & Rehab
Organization subpart
No

Provider details

NPI number
Authorized official
KENDALL A BROUSSARD (MANAGING MEMBER)
(337) 439-6600
Entity
Organization

Contact information

Practice address
900 W LEUDA ST, FORT WORTH, TX 76104-3002
(337) 439-6600
(337) 439-6647
Mailing address
127 W BROAD ST STE 800, LAKE CHARLES, LA 70601-4297
(337) 439-6600
(337) 439-6647

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
136289
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001025543
TX
05
004002
TX
05
4002
TX
Enumeration date
10/16/2013
Last updated
12/11/2013
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