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NPI Code Detail

MEDICARE: MASON COPPELL OP LLC

MEDICARE: MASON COPPELL OP 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 Facility131895TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2104250OTHERTXFACILITY ID

General Provider Information

NPI Number : 1568799914
Entity Type Code : Organization
Provider Name (Legal Business Name) : MASON COPPELL OP LLC
Provider Business Mailing Address
First Line : 1410 E SANDY LAKE RD
Second Line :
City : COPPELL
State : TX
Zip : 75019-3119
Country : US
Telephone Number : 972-304-4444
Fax Number : 972-462-6605
Provider Business Practice Location Address
First Line : 1410 E SANDY LAKE RD
Second Line :
City : COPPELL
State : TX
Zip : 75019-3119
Country : US
Telephone Number : 972-304-4444
Fax Number : 972-462-6605
Authorized Official
Title or Position : ADMINISTRATOR
Name : MARILYN D. HODGES
Credential :
Telephone Number : 972-304-4444
Provider Enumeration Date : 11/05/2009
Last Update Date : 08/02/2012

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