MEDICARE: STRATEGIC CARE OF STEPHENVILLE, 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	005085	TX
2	314000000X	Skilled Nursing Facility	122400	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

General Provider Information

NPI Number	:	1871780924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRATEGIC CARE OF STEPHENVILLE, LLC

Provider Business Mailing Address
First Line	:	2309 W WASHINGTON STREET
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-3805
Country	:	US
Telephone Number	:	254-968-4191
Fax Number	:	254-968-0862

Provider Business Practice Location Address
First Line	:	2309 W WASHINGTON STREET
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-3805
Country	:	US
Telephone Number	:	254-968-4191
Fax Number	:	254-968-0862

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAYLA SLATER
Credential	:	RN, CWOCN
Telephone Number	:	817-808-7012

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	01/27/2009

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