Healthcare Provider Details

I. General information

NPI: 1144229378
Provider Name (Legal Business Name): SENIOR HEALTH BREMOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH MAIN
BREMOND TX
76629
US

IV. Provider business mailing address

2601 SAGEBRUSH DR SUITE 103
FLOWER MOUND TX
75028
US

V. Phone/Fax

Practice location:
  • Phone: 254-746-7666
  • Fax: 254-747-5075
Mailing address:
  • Phone: 972-410-2600
  • Fax: 972-410-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number118977
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number112306
License Number StateTX

VIII. Authorized Official

Name: LARRY LEE SNOW
Title or Position: REG CASE MANAGER
Credential: RN
Phone: 972-410-2600