Provider Demographics
NPI:1972591717
Name:SENIOR LIVING PROPERTIES
Entity type:Organization
Organization Name:SENIOR LIVING PROPERTIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:972-291-7877
Mailing Address - Street 1:230 S CLARK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2750
Mailing Address - Country:US
Mailing Address - Phone:972-291-7877
Mailing Address - Fax:972-293-1273
Practice Address - Street 1:230 S CLARK RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2750
Practice Address - Country:US
Practice Address - Phone:972-291-7877
Practice Address - Fax:972-293-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110448314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675032Medicare ID - Type Unspecified