Healthcare Provider Details

I. General information

NPI: 1962823401
Provider Name (Legal Business Name): HOLLYMEAD CONTINUING CARE CENTER LTD. CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 LONG PRAIRIE RD
FLOWER MOUND TX
75028-1567
US

IV. Provider business mailing address

2537 GOLDEN BEAR DR
CARROLLTON TX
75006-2377
US

V. Phone/Fax

Practice location:
  • Phone: 214-954-4114
  • Fax: 214-880-0053
Mailing address:
  • Phone: 214-954-4114
  • Fax: 214-880-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LISA MICHELLE SMITH
Title or Position: LEGAL ASSISTANT
Credential:
Phone: 214-954-4114