Healthcare Provider Details

I. General information

NPI: 1811949456
Provider Name (Legal Business Name): SLP HAMLIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date: 05/25/2006
Reactivation Date: 11/15/2006

III. Provider practice location address

425 SW AVENUE F
HAMLIN TX
79520-4615
US

IV. Provider business mailing address

1300 S. UNIVERSITY DR. SUITE 306
FORT WORTH TX
76107
US

V. Phone/Fax

Practice location:
  • Phone: 325-576-3643
  • Fax: 325-576-3913
Mailing address:
  • Phone: 817-410-7300
  • Fax: 817-423-6270

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/COO
Credential:
Phone: 817-410-7300