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General NPI Number Information
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NPI Number | 1245795970
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Entity Type | Organization
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Legal Business Name | SHADOW MOUNTAIN LUXURY SENIOR LIVING CORPORATION
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 13000 COWPER DR
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City | FRISCO
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State | TX
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Zip | 75035-2220
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Country | US
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Telephone | 214-399-9099
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Fax |
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Provider Business Mailing Address
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Address Line | 13000 COWPER DR
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City | FRISCO
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State | TX
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Zip | 75035-2220
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Country | US
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Telephone | 214-399-9099
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIET OTIENO
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Credential |
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Telephone | 214-399-9099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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