Healthcare Provider Details

I. General information

NPI: 1912931015
Provider Name (Legal Business Name): SLP LAPORTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S UTAH ST
LA PORTE TX
77571-5555
US

IV. Provider business mailing address

1300 S UNIVERSITY DR SUITE 306
FORT WORTH TX
76107-5737
US

V. Phone/Fax

Practice location:
  • Phone: 281-471-1810
  • Fax: 281-471-8809
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