Provider Demographics
NPI:1306108592
Name:CSL CE STEPHENVILLE, LLC
Entity type:Organization
Organization Name:CSL CE STEPHENVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-244-2300
Mailing Address - Street 1:14160 DALLAS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-4383
Mailing Address - Country:US
Mailing Address - Phone:972-308-8366
Mailing Address - Fax:972-387-8216
Practice Address - Street 1:2010 GOOD TREE ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-6026
Practice Address - Country:US
Practice Address - Phone:254-965-9897
Practice Address - Fax:254-918-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility