Provider Demographics
NPI:1083878953
Name:SLB LEWISVILLE CLINIC I, LLC
Entity Type:Organization
Organization Name:SLB LEWISVILLE CLINIC I, LLC
Other - Org Name:LIFE STEPS LEWISVILLE I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKELHAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-478-4297
Mailing Address - Street 1:3501 N MACARTHUR BLVD STE 350A
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3651
Mailing Address - Country:US
Mailing Address - Phone:972-353-5437
Mailing Address - Fax:972-353-5436
Practice Address - Street 1:3501 N MACARTHUR BLVD STE 350A
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3651
Practice Address - Country:US
Practice Address - Phone:972-353-5437
Practice Address - Fax:972-353-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)