MEDICARE: SENIOR HEALTH NORTHWOOD 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	112335	TX

General Provider Information

NPI Number	:	1023018884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HEALTH NORTHWOOD LLC

Provider Business Mailing Address
First Line	:	1109 NORTHWOOD DR
Second Line	:
City	:	MARBLE FALLS
State	:	TX
Zip	:	78654-0000
Country	:	US
Telephone Number	:	830-693-3551
Fax Number	:	830-693-7266

Provider Business Practice Location Address
First Line	:	1109 NORTHWOOD DR
Second Line	:
City	:	MARBLE FALLS
State	:	TX
Zip	:	78654-0000
Country	:	US
Telephone Number	:	830-693-3551
Fax Number	:	830-693-7266

Authorized Official
Title or Position	:	REGIONAL CASE MANAGER
Name	:	MR. LARRY LEE SNOW
Credential	:	RN
Telephone Number	:	940-464-7016

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	10/03/2007

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