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NPI Code Detail

MEDICARE: LS SAN SABA OPERATOR LLC

MEDICARE: LS SAN SABA OPERATOR 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1407318546
Entity Type Code : Organization
Provider Name (Legal Business Name) : LS SAN SABA OPERATOR LLC
Provider Business Mailing Address
First Line : 6300 WILSHIRE BLVD STE 1800
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048-5236
Country : US
Telephone Number : 323-651-1808
Fax Number :
Provider Business Practice Location Address
First Line : 1405 W STOREY ST
Second Line :
City : SAN SABA
State : TX
Zip : 76877-6422
Country : US
Telephone Number : 325-372-5112
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICER
Name : MARK LAZAR
Credential :
Telephone Number : 323-651-1808
Provider Enumeration Date : 04/05/2019
Last Update Date : 04/05/2019

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Directions to “LS SAN SABA OPERATOR LLC ” Practice Location

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