Healthcare Provider Details

I. General information

NPI: 1487966537
Provider Name (Legal Business Name): CSL MIRACLE HILLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11909 MIRACLE HILLS DR
OMAHA NE
68154
US

IV. Provider business mailing address

14160 DALLAS PARKWAY SUITE 300
DALLAS TX
75254
US

V. Phone/Fax

Practice location:
  • Phone: 402-431-0011
  • Fax: 402-431-9257
Mailing address:
  • Phone: 972-770-5600
  • Fax: 972-770-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF156
License Number StateNE

VIII. Authorized Official

Name: MRS. GLORIA HOLLAND
Title or Position: VP-FINANCE
Credential:
Phone: 972-770-5600