MEDICARE: SENIOR LIVING PROPERTIES 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	310400000X	Assisted Living Facility	123571	TX

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
2	000634	OTHER	TX	FACILITY ID NO.

General Provider Information

NPI Number	:	1487642666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR LIVING PROPERTIES LLC

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

Provider Business Practice Location Address
First Line	:	1201 CHERRY ST
Second Line	:
City	:	GRAHAM
State	:	TX
Zip	:	76450-3829
Country	:	US
Telephone Number	:	940-549-7513
Fax Number	:	940-549-3425

Authorized Official
Title or Position	:	CFO
Name	:	LARRY MARTIN
Credential	:
Telephone Number	:	817-410-7300

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/07/2008

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Directions to “SENIOR LIVING PROPERTIES LLC ” Practice Location

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