Provider Demographics
NPI:1033829932
Name:LOH OPS GRAND SALINE COUNTRY TRAILS LLC
Entity Type:Organization
Organization Name:LOH OPS GRAND SALINE COUNTRY TRAILS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-286-3998
Mailing Address - Street 1:1638 VZ COUNTY ROAD 1803
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-3494
Mailing Address - Country:US
Mailing Address - Phone:903-962-7595
Mailing Address - Fax:903-962-7202
Practice Address - Street 1:1638 VZ COUNTY ROAD 1803
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-3494
Practice Address - Country:US
Practice Address - Phone:903-962-7595
Practice Address - Fax:903-962-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility