MEDICARE: ALTAMONTE CARE OF RICHLAND HILLS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1104461516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTAMONTE CARE OF RICHLAND HILLS, LLC

Provider Business Mailing Address
First Line	:	525 GRANT PARK CT
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7316
Country	:	US
Telephone Number	:	949-412-8233
Fax Number	:

Provider Business Practice Location Address
First Line	:	7146 BAKER BLVD
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76118-5801
Country	:	US
Telephone Number	:	817-589-1734
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	LOGAN SEXTON
Credential	:
Telephone Number	:	949-412-8233

Provider Enumeration Date	:	11/08/2019
Last Update Date	:	06/11/2020

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