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General NPI Number Information
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NPI Number | 1619238425
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Entity Type | Organization
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Legal Business Name | MASON MESQUITE OP, LLC
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 1101 WINDBELL DRIVE
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City | MESQUITE
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State | TX
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Zip | 75149
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Country | US
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Telephone | 469-341-2720
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Fax |
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Provider Business Mailing Address
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Address Line | 4949 WESTGROVE DR SUITE 200
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City | DALLAS
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State | TX
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Zip | 75248-1923
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Country | US
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Telephone | 469-341-2720
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | M. CRAIG KELLY
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Credential |
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Telephone | 469-341-2720
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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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