Healthcare Provider Details

I. General information

NPI: 1235126103
Provider Name (Legal Business Name): SENIOR HEALTH - MEADOWBROOK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WINDSOR DR.
VAN ALSTYNE TX
75495-0307
US

IV. Provider business mailing address

PO BOX 307
VAN ALSTYNE TX
75495-0307
US

V. Phone/Fax

Practice location:
  • Phone: 903-482-6455
  • Fax: 903-482-6048
Mailing address:
  • Phone: 903-482-6455
  • Fax: 903-482-6048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number675151
License Number StateTX

VIII. Authorized Official

Name: LARRY SNOW
Title or Position: REGIONAL CASE MANAGER
Credential:
Phone: 972-410-2600