Provider Demographics
NPI:1588725592
Name:FWM HEALTHCARE, LLC DBA FT. WORTH MANOR
Entity type:Organization
Organization Name:FWM HEALTHCARE, LLC DBA FT. WORTH MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-514-2203
Mailing Address - Street 1:2712 HURSTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2402
Mailing Address - Country:US
Mailing Address - Phone:817-514-2203
Mailing Address - Fax:817-281-6717
Practice Address - Street 1:4900 E BERRY ST
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-4314
Practice Address - Country:US
Practice Address - Phone:817-531-3707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility