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General NPI Number Information
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NPI Number | 1346544855
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Entity Type | Organization
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Legal Business Name | MODERN SENIOR LIVING LLC
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 3808 S CENTRAL EXPY
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City | DALLAS
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State | TX
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Zip | 75215-3701
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Country | US
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Telephone | 214-428-5851
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Fax |
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Provider Business Mailing Address
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Address Line | 4124 GUS THOMASSON ROAD
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City | MESQUITE
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State | TX
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Zip | 75150
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. TROY P ISSAC
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Credential |
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Telephone | 972-669-1243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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