Charleston DFW Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

136289 Issued in TX

Legal business name

CHARLESTON DFW OPERATIONS LLC

Doing business as

DFW Nursing & Rehab

Practice address

900 W Leuda St
Fort Worth, TX 76104-3002

Phone

(337) 439-6600

Fax

(337) 439-6647

NPI assigned

Oct 16, 2013

Organization subpart

No

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

Authorized official

Name

Kendall A Broussard

Title

Managing Member

Phone

(337) 439-6600

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• DFW Nursing & Rehab Doing business as

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1851729560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 W BROAD ST STE 800",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706014297",
            "telephone_number": "337-439-6600",
            "fax_number": "337-439-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W LEUDA ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043002",
            "telephone_number": "337-439-6600",
            "fax_number": "337-439-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON DFW OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "337-439-6600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "136289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004002",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001025543",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DFW Nursing & Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vanessa S Charette, MD
• Charis Healthcare Solutions LLC
• Charles David Braungardt
• Charles G. Langham III, M.D., P.a.
• Danielle Charles
• Hermenegildo Charrez-Baxcajay, MD
• Gerald L Chase, MD
• Jeffrey A Chase, MD
• Nicole Ann Chase, RD
• Whitney Chase, CPNP-AC

• Skilled Nursing Facility in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; 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.