Healthcare Provider Details

I. General information

NPI: 1033829932
Provider Name (Legal Business Name): LOH OPS GRAND SALINE COUNTRY TRAILS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 VZ COUNTY ROAD 1803
GRAND SALINE TX
75140-3494
US

IV. Provider business mailing address

1638 VZ COUNTY ROAD 1803
GRAND SALINE TX
75140-3494
US

V. Phone/Fax

Practice location:
  • Phone: 903-962-7595
  • Fax: 903-962-7202
Mailing address:
  • Phone: 903-962-7595
  • Fax: 903-962-7202

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: JOSHUA LEONARD
Title or Position: MANAGER
Credential:
Phone: 682-286-3998