MEDICARE: FAIRPARK SCC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003051855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRPARK SCC LLC

Provider Business Mailing Address
First Line	:	2815 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-2320
Country	:	US
Telephone Number	:	214-421-2159
Fax Number	:	214-428-2303

Provider Business Practice Location Address
First Line	:	2815 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-2320
Country	:	US
Telephone Number	:	214-421-2159
Fax Number	:	214-428-2303

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	JASON PRICE
Credential	:
Telephone Number	:	949-436-4343

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	09/04/2020

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Directions to “FAIRPARK SCC LLC ” Practice Location

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