Healthcare Provider Details

I. General information

NPI: 1356967624
Provider Name (Legal Business Name): SLP ORANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CARDINAL ST
ORANGE TX
77630-4737
US

IV. Provider business mailing address

1300 S UNIVERSITY DR STE 306
FT WORTH TX
76107-5746
US

V. Phone/Fax

Practice location:
  • Phone: 409-883-5727
  • Fax: 409-883-9078
Mailing address:
  • Phone: 817-410-7300
  • Fax:

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: CASSANDRA MISTRETTA
Title or Position: CEO
Credential:
Phone: 817-410-7300