Healthcare Provider Details

I. General information

NPI: 1871780924
Provider Name (Legal Business Name): STRATEGIC CARE OF STEPHENVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 W WASHINGTON STREET
STEPHENVILLE TX
76401-3805
US

IV. Provider business mailing address

2309 W WASHINGTON STREET
STEPHENVILLE TX
76401-3805
US

V. Phone/Fax

Practice location:
  • Phone: 254-968-4191
  • Fax: 254-968-0862
Mailing address:
  • Phone: 254-968-4191
  • Fax: 254-968-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number005085
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number122400
License Number StateTX

VIII. Authorized Official

Name: KAYLA SLATER
Title or Position: PRESIDENT
Credential: RN, CWOCN
Phone: 817-808-7012