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NPI Code Detail

MEDICARE: S-H OPCO SPICEWOOD SPRINGS, LLC

MEDICARE: S-H OPCO SPICEWOOD SPRINGS, 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 Facility129734TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
167-5533OTHERMEDICARE PTAN

General Provider Information

NPI Number : 1770807216
Entity Type Code : Organization
Provider Name (Legal Business Name) : S-H OPCO SPICEWOOD SPRINGS, LLC
Provider Business Mailing Address
First Line : 6737 W WASHINGTON ST
Second Line : SUITE 2300
City : MILWAUKEE
State : WI
Zip : 53214-5647
Country : US
Telephone Number : 414-918-5332
Fax Number :
Provider Business Practice Location Address
First Line : 4401 SPICEWOOD SPRINGS RD
Second Line :
City : AUSTIN
State : TX
Zip : 78759-8682
Country : US
Telephone Number : 512-418-8822
Fax Number : 512-418-8825
Authorized Official
Title or Position : PRESIDENT
Name : MR. MARK W OHLENDORF
Credential :
Telephone Number : 414-918-5000
Provider Enumeration Date : 03/25/2010
Last Update Date : 12/29/2015

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