Healthcare Provider Details

I. General information

NPI: 1386395507
Provider Name (Legal Business Name): LSREF GOLDEN OPS 26 (TX), LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 205 LOOP
TEMPLE TX
76502-4097
US

IV. Provider business mailing address

5320 205 LOOP
TEMPLE TX
76502-4097
US

V. Phone/Fax

Practice location:
  • Phone: 254-633-2003
  • Fax:
Mailing address:
  • Phone: 254-633-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN J LEVY
Title or Position: AGENT FOR OWNER
Credential:
Phone: 312-673-4470