MEDICARE: SENIOR HEALTH RICHLAND 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	4530	TX

General Provider Information

NPI Number	:	1538167622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HEALTH RICHLAND LLC

Provider Business Mailing Address
First Line	:	3109 KINGS COURT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-0000
Country	:	US
Telephone Number	:	817-589-2431
Fax Number	:	817-284-2431

Provider Business Practice Location Address
First Line	:	3109 KINGS COURT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-0000
Country	:	US
Telephone Number	:	817-589-2431
Fax Number	:	817-284-2431

Authorized Official
Title or Position	:	REGIONAL CASE MANAGER
Name	:	MR. LARRY LEE SNOW
Credential	:
Telephone Number	:	940-464-7016

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	10/03/2007

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Directions to “SENIOR HEALTH RICHLAND LLC ” Practice Location

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