Healthcare Provider Details

I. General information

NPI: 1538557335
Provider Name (Legal Business Name): MILL FOREST ROAD SCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17231 MILL FOREST RD
WEBSTER TX
77598-4308
US

IV. Provider business mailing address

600 N PEARL ST STE 1050
DALLAS TX
75201-7495
US

V. Phone/Fax

Practice location:
  • Phone: 281-488-5224
  • Fax: 281-461-8576
Mailing address:
  • Phone: 214-252-7600
  • Fax: 214-252-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL BEAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 214-252-7600