=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861628034
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SELECT OPERATIONS OF CARROLLTON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2009
-----------------------------------------------------
Last Update Date | 06/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1029 SEMINOLE TRL
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75007-6200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-753-6262
-----------------------------------------------------
Fax | 888-753-6262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 MEDICAL CENTER DR SUITE 9
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73034-6359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-753-6262
-----------------------------------------------------
Fax | 888-753-6262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | ERIC LINDSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-753-6262
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311500000X
-----------------------------------------------------
Taxonomy Name | Alzheimer Center (Dementia Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 000305
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------