Provider Demographics
NPI:1528056215
Name:SENIORLIVINGPROPERTIES
Entity type:Organization
Organization Name:SENIORLIVINGPROPERTIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADM
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-629-2686
Mailing Address - Street 1:1405 WEST COMMERCE
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-2327
Mailing Address - Country:US
Mailing Address - Phone:254-629-2686
Mailing Address - Fax:254-629-8797
Practice Address - Street 1:1405 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2327
Practice Address - Country:US
Practice Address - Phone:254-629-2686
Practice Address - Fax:254-629-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110147314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility