Fort Worth Senior Care, LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

FORT WORTH SENIOR CARE, LLC

Doing business as

Christian Care Outpatient Therapy

Practice address

5100 Randol Mill Rd
Fort Worth, TX 76112-1553

Phone

(817) 548-3200

Fax

(817) 529-0768

NPI assigned

Oct 28, 2022

Last updated

Aug 19, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cynthia Matheny

Title

Manager

Phone

(423) 883-7920

Specialties & licenses 1

Addresses

Other names 1

• Christian Care Outpatient Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Christian Care Outpatient Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fort Worth Senior Care, LLC

  dba Lakewood Village Personal Care Unit

  • Physical Disabilities Residential Treatment Facility
  • Fort Worth, TX
  • NPI 1952133886
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1043927247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 RANDOL MILL RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761121553",
            "telephone_number": "817-548-3200",
            "fax_number": "817-529-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 RANDOL MILL RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761121553",
            "telephone_number": "817-548-3200",
            "fax_number": "817-529-0768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH SENIOR CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-28",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "MATHENY",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "423-883-7920"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christian Care Outpatient Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fort Worth Proctologic Clinic, PA
• Fort Worth Psychworks, PLLC
• Fort Worth Radiology, PLLC
• Fort Worth Recovery LLC
• Fort Worth Rehab Group
• Fort Worth Senior Care, LLC (Lakewood Village Personal Care Unit)
• Fort Worth Skilled Care, LLC (Immanuels Healthcare)
• Fort Worth Sleep Labs
• Fort Worth Sleep LLC
• Fort Worth Smile Studio P.L.L.C.

• Rehabilitation Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Rehabilitation Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.