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General NPI Number Information
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NPI Number | 1386395507
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Entity Type | Organization
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Legal Business Name | LSREF GOLDEN OPS 26 (TX), LLC
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 5320 205 LOOP
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City | TEMPLE
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State | TX
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Zip | 76502-4097
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Country | US
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Telephone | 254-633-2003
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Fax |
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Provider Business Mailing Address
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Address Line | 5320 205 LOOP
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City | TEMPLE
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State | TX
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Zip | 76502-4097
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Country | US
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Telephone | 254-633-2003
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Fax |
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Authorized Official
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Title or Position | AGENT FOR OWNER
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Name | STEPHEN J LEVY
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Credential |
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Telephone | 312-673-4470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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