Healthcare Provider Details

I. General information

NPI: 1306259122
Provider Name (Legal Business Name): LCS-SP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14655 PRESTON RD
DALLAS TX
75254-7805
US

IV. Provider business mailing address

14655 PRESTON RD
DALLAS TX
75254-7805
US

V. Phone/Fax

Practice location:
  • Phone: 972-726-7575
  • Fax:
Mailing address:
  • Phone: 972-726-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number135188
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number134998
License Number StateTX

VIII. Authorized Official

Name: KEVIN EDEN
Title or Position: MANAGER
Credential:
Phone: 214-220-4909