Healthcare Provider Details

I. General information

NPI: 1093769325
Provider Name (Legal Business Name): SENIOR LIVING PROPERTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 S OAK ST
VAN TX
75790-3529
US

IV. Provider business mailing address

PO BOX 1389
GRAPEVINE TX
76099-1389
US

V. Phone/Fax

Practice location:
  • Phone: 903-963-8641
  • Fax: 903-963-5413
Mailing address:
  • Phone: 817-410-7300
  • Fax: 817-410-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number123157
License Number StateTX

VIII. Authorized Official

Name: LARRY MARTIN
Title or Position: CFO
Credential:
Phone: 817-410-7300