Healthcare Provider Details

I. General information

NPI: 1063465375
Provider Name (Legal Business Name): SENIOR LIVING PROPERTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date: 05/25/2006
Reactivation Date: 11/29/2006

III. Provider practice location address

230 S CLARK RD
CEDAR HILL TX
75104-2750
US

IV. Provider business mailing address

PO BOX 1389
GRAPEVINE TX
76099-1389
US

V. Phone/Fax

Practice location:
  • Phone: 972-291-7877
  • Fax: 972-293-1273
Mailing address:
  • Phone: 817-410-7300
  • Fax: 817-810-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number123138
License Number StateTX

VIII. Authorized Official

Name: JAMES O ROGERS IV
Title or Position: COO
Credential:
Phone: 817-410-7300