Healthcare Provider Details

I. General information

NPI: 1205223096
Provider Name (Legal Business Name): S-H THIRTY-FIVE OPCO - TEMPLE MERIDIAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 S 31ST ST
TEMPLE TX
76502-3313
US

IV. Provider business mailing address

4312 S 31ST ST
TEMPLE TX
76502-3313
US

V. Phone/Fax

Practice location:
  • Phone: 254-771-1226
  • Fax:
Mailing address:
  • Phone: 254-771-1226
  • Fax: 254-774-7472

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: MATTHEW HARRISON
Title or Position: VICE PRESIDENT/CORPORATE SECRETARY
Credential:
Phone: 949-407-0700