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NPI Code Detail

MEDICARE: SH OPCO GOOD PLACE, LLC

MEDICARE: SH OPCO GOOD PLACE, 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
1310400000XAssisted Living Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1147031OTHERTXTEXAS HEALTH AND HUMAN SERVICES COMMISSION

General Provider Information

NPI Number : 1417575127
Entity Type Code : Organization
Provider Name (Legal Business Name) : SH OPCO GOOD PLACE, LLC
Provider Business Mailing Address
First Line : 14160 DALLAS PKWY STE 300
Second Line :
City : DALLAS
State : TX
Zip : 75254-4383
Country : US
Telephone Number : 972-308-8391
Fax Number :
Provider Business Practice Location Address
First Line : 7801 N RICHLAND BLVD
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-6415
Country : US
Telephone Number : 817-581-6310
Fax Number :
Authorized Official
Title or Position : AR MANAGER
Name : DARLA BROWN
Credential :
Telephone Number : 972-308-8391
Provider Enumeration Date : 07/09/2020
Last Update Date : 11/05/2020

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Directions to “SH OPCO GOOD PLACE, LLC ” Practice Location

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