1356397152 NPI number — SENIOR LIVING PROPERTIES LLC

Table of content: (NPI 1356397152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356397152 NPI number — SENIOR LIVING PROPERTIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIOR LIVING PROPERTIES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLAYSTONE HEALTHCARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356397152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1389
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76099-1389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-410-7300
Provider Business Mailing Address Fax Number:
817-810-7411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 S CLAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENNIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75119-6414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-875-8411
Provider Business Practice Location Address Fax Number:
972-875-3626
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
817-410-7300

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  122529 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005027 . This is a "FACILITY ID NO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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