Healthcare Provider Details

I. General information

NPI: 1104069830
Provider Name (Legal Business Name): MEADOWCREST SPECIALTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 COMMERCE ST SUITE B
GRETNA LA
70056-7316
US

IV. Provider business mailing address

415 HIGHWAY 377 S STE 200
ARGYLE TX
76226-5140
US

V. Phone/Fax

Practice location:
  • Phone: 940-464-7018
  • Fax:
Mailing address:
  • Phone: 940-464-7018
  • Fax: 940-464-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: CHANA D SHELTON
Title or Position: CFO
Credential:
Phone: 940-464-7018