Provider Demographics
NPI:1063662393
Name:MT. SHENIR, LLC
Entity Type:Organization
Organization Name:MT. SHENIR, LLC
Other - Org Name:LIFESTEPS REHABILITATION OF CARROLTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:UPSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-277-1168
Mailing Address - Street 1:2908 E TRINITY MILLS RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2318
Mailing Address - Country:US
Mailing Address - Phone:214-277-1168
Mailing Address - Fax:
Practice Address - Street 1:2908 E TRINITY MILLS RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2318
Practice Address - Country:US
Practice Address - Phone:214-277-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)