Healthcare Provider Details

I. General information

NPI: 1134847148
Provider Name (Legal Business Name): MESQUITE SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WIGGINS PKWY
MESQUITE TX
75150-7465
US

IV. Provider business mailing address

1000 WIGGINS PKWY
MESQUITE TX
75150-7465
US

V. Phone/Fax

Practice location:
  • Phone: 972-686-3000
  • Fax: 972-698-2671
Mailing address:
  • Phone: 972-686-3000
  • Fax: 972-698-2671

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: CYNDI MATHENY
Title or Position: PRESIDENT OF MANAGER
Credential:
Phone: 423-883-7920