=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487642666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR LIVING PROPERTIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2005
-----------------------------------------------------
Last Update Date | 07/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 CHERRY ST
-----------------------------------------------------
City | GRAHAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76450-3829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-549-7513
-----------------------------------------------------
Fax | 940-549-3425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1389
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76099-1389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-410-7300
-----------------------------------------------------
Fax | 817-810-7411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | LARRY MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-410-7300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 123571
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------