MEDICARE: SELECT OPERATIONS OF CARROLLTON 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	311500000X	Alzheimer Center (Dementia Center)		TX
2	310400000X	Assisted Living Facility	000305	TX

General Provider Information

NPI Number	:	1861628034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELECT OPERATIONS OF CARROLLTON LLC

Provider Business Mailing Address
First Line	:	1601 MEDICAL CENTER DR
Second Line	:	SUITE 9
City	:	EDMOND
State	:	OK
Zip	:	73034-6359
Country	:	US
Telephone Number	:	888-753-6262
Fax Number	:	888-753-6262

Provider Business Practice Location Address
First Line	:	1029 SEMINOLE TRL
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-6200
Country	:	US
Telephone Number	:	888-753-6262
Fax Number	:	888-753-6262

Authorized Official
Title or Position	:	MANAGER
Name	:	ERIC LINDSEY
Credential	:
Telephone Number	:	888-753-6262

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/30/2009

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