Healthcare Provider Details

I. General information

NPI: 1356397152
Provider Name (Legal Business Name): SENIOR LIVING PROPERTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S CLAY ST
ENNIS TX
75119-6414
US

IV. Provider business mailing address

PO BOX 1389
GRAPEVINE TX
76099-1389
US

V. Phone/Fax

Practice location:
  • Phone: 972-875-8411
  • Fax: 972-875-3626
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 Number122529
License Number StateTX

VIII. Authorized Official

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