Provider Demographics
NPI:1124022470
Name:SENIOR CARE SERVICES
Entity Type:Organization
Organization Name:SENIOR CARE SERVICES
Other - Org Name:THE VINTAGE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-303-9000
Mailing Address - Street 1:1413 EAST I 30
Mailing Address - Street 2:STE 7
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4598
Mailing Address - Country:US
Mailing Address - Phone:972-303-9000
Mailing Address - Fax:972-303-9992
Practice Address - Street 1:205 N BONNIE BRAE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3766
Practice Address - Country:US
Practice Address - Phone:972-303-9000
Practice Address - Fax:972-303-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004939314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH2663OtherBCBS
TX675939Medicare Oscar/Certification
TX1264760002Medicare NSC