Healthcare Provider Details

I. General information

NPI: 1861628034
Provider Name (Legal Business Name): SELECT OPERATIONS OF CARROLLTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 SEMINOLE TRL
CARROLLTON TX
75007-6200
US

IV. Provider business mailing address

1601 MEDICAL CENTER DR SUITE 9
EDMOND OK
73034-6359
US

V. Phone/Fax

Practice location:
  • Phone: 888-753-6262
  • Fax: 888-753-6262
Mailing address:
  • Phone: 888-753-6262
  • Fax: 888-753-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number000305
License Number StateTX

VIII. Authorized Official

Name: ERIC LINDSEY
Title or Position: MANAGER
Credential:
Phone: 888-753-6262