MEDICARE: SENIOR HEALTH - MEADOWBROOK, 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	675151	TX

General Provider Information

NPI Number	:	1235126103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HEALTH - MEADOWBROOK, LLC

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	VAN ALSTYNE
State	:	TX
Zip	:	75495-0307
Country	:	US
Telephone Number	:	903-482-6455
Fax Number	:	903-482-6048

Provider Business Practice Location Address
First Line	:	100 WINDSOR DR.
Second Line	:
City	:	VAN ALSTYNE
State	:	TX
Zip	:	75495-0307
Country	:	US
Telephone Number	:	903-482-6455
Fax Number	:	903-482-6048

Authorized Official
Title or Position	:	REGIONAL CASE MANAGER
Name	:	LARRY SNOW
Credential	:
Telephone Number	:	972-410-2600

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	08/22/2020

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