Southwest LTC - Fort Worth Alf, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

145897 Issued in TX

Legal business name

SOUTHWEST LTC - FORT WORTH ALF, LLC

Practice address

6931 River Park Cir
Fort Worth, TX 76116-8465

Phone

(817) 731-7611

Fax

(817) 731-4909

NPI assigned

Mar 31, 2017

Organization subpart

No

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

Authorized official

Name

Ronald Payne

Title

Manager

Phone

(469) 916-6100

Specialties & licenses 1

Addresses

Other names 1

• Colonial Gardens of Fort Worth FW-2 Doing business as

Tax ID family

Colonial Gardens of Fort Worth FW-12 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.

• Southwest LTC - Fort Worth Alf, LLC

  • Assisted Living Facility
  • Fort Worth, TX
  • NPI 1558893701
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacy Millen, PTA

  • Physical Therapy Assistant
  • Fort Worth, TX
  • NPI 1538040381
  NPD (past)

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

{
    "created_epoch": "1490918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636588800000",
    "number": "1760914469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5560 TENNYSON PKWY STE 210",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750243582",
            "telephone_number": "469-916-6100",
            "fax_number": "469-916-6105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6931 RIVER PARK CIR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761168465",
            "telephone_number": "817-731-7611",
            "fax_number": "817-731-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LTC - FORT WORTH ALF, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-31",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "469-916-6100"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "145897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Gardens of Fort Worth FW-2",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colonial Gardens of Fort Worth FW-2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Southwest Fort Worth Memory Care, LLC
• Southwest Home Care, LLC
• Southwest Internal Medicine PA
• Southwest LTC - Fort Worth Alf, LLC
• Southwest Physical Medicine, PLLC
• Southwest Spine Waves LLC
• Southwest Surgical Associates
• Southwestern Baptist Theological Seminary
• Southwestern LLC

• Assisted Living Facility in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.