Provider Demographics
NPI:1306487426
Name:FORT HEALTHCARE LLC
Entity type:Organization
Organization Name:FORT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BENARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SODEK
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:817-678-7428
Mailing Address - Street 1:7140 OAKMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3900
Mailing Address - Country:US
Mailing Address - Phone:817-678-7428
Mailing Address - Fax:
Practice Address - Street 1:5833 OAKBEND TRAIL
Practice Address - Street 2:#200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3900
Practice Address - Country:US
Practice Address - Phone:817-678-7428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities