Healthcare Provider Details

I. General information

NPI: 1841509015
Provider Name (Legal Business Name): BRYAN SNF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4091 EASTCHESTER DR
BRYAN TX
77802-4732
US

IV. Provider business mailing address

5307 E MOCKINGBIRD LN SUITE 1010
DALLAS TX
75206-5109
US

V. Phone/Fax

Practice location:
  • Phone: 979-774-3401
  • Fax: 979-774-3021
Mailing address:
  • Phone: 214-370-2600
  • Fax: 214-370-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG WILLARD SPAULDING
Title or Position: MANAGER
Credential: CPA
Phone: 214-370-2600