Provider Demographics
NPI:1386949220
Name:REMARKABLE HEALTHCARE OF FORT WORTH, LP
Entity type:Organization
Organization Name:REMARKABLE HEALTHCARE OF FORT WORTH, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MCPIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-308-6226
Mailing Address - Street 1:PO BOX 164966
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-4966
Mailing Address - Country:US
Mailing Address - Phone:817-847-1860
Mailing Address - Fax:817-847-0685
Practice Address - Street 1:6649 NORTH RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137
Practice Address - Country:US
Practice Address - Phone:817-847-1860
Practice Address - Fax:817-847-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
TX139958314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001019361Medicaid
TX001019361Medicaid