Healthcare Provider Details

I. General information

NPI: 1154812089
Provider Name (Legal Business Name): LOH ELKHART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2018
Last Update Date: 05/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 JONES RD
ELKHART TX
75839-7605
US

IV. Provider business mailing address

2830 S HULEN ST STE 382
FORT WORTH TX
76109-1514
US

V. Phone/Fax

Practice location:
  • Phone: 903-764-2291
  • Fax:
Mailing address:
  • Phone: 404-556-7052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSHUA LEONARD
Title or Position: PRESIDENT
Credential:
Phone: 404-556-7052