Healthcare Provider Details

I. General information

NPI: 1629072962
Provider Name (Legal Business Name): SENIOR CARE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NORTH MAIN
SAVOY TX
75479
US

IV. Provider business mailing address

1413 EAST I 30 STE 7
GARLAND TX
75043-4598
US

V. Phone/Fax

Practice location:
  • Phone: 972-303-9000
  • Fax: 972-303-9992
Mailing address:
  • Phone: 972-303-9000
  • Fax: 972-303-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number004060
License Number StateTX

VIII. Authorized Official

Name: SHANE LEWIS
Title or Position: VP CFO
Credential:
Phone: 972-303-9000