Healthcare Provider Details

I. General information

NPI: 1336483619
Provider Name (Legal Business Name): SLH CEDAR PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S LAKELINE BLVD
CEDAR PARK TX
78613-4567
US

IV. Provider business mailing address

111 E WACKER DR
CHICAGO IL
60601-3713
US

V. Phone/Fax

Practice location:
  • Phone: 512-219-0200
  • Fax: 512-219-0466
Mailing address:
  • Phone: 312-673-4387
  • Fax: 312-673-4487

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: STEPHEN LEVY
Title or Position: MANAGER
Credential:
Phone: 312-673-4387