Provider Demographics
NPI:1144229378
Name:SENIOR HEALTH BREMOND LLC
Entity Type:Organization
Organization Name:SENIOR HEALTH BREMOND LLC
Other - Org Name:BREMOND NURSING AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REG CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-410-2600
Mailing Address - Street 1:2601 SAGEBRUSH DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-410-2600
Mailing Address - Fax:972-410-2601
Practice Address - Street 1:200 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:BREMOND
Practice Address - State:TX
Practice Address - Zip Code:76629
Practice Address - Country:US
Practice Address - Phone:254-746-7666
Practice Address - Fax:254-747-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112306314000000X
TX118977314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675132Medicare ID - Type UnspecifiedFACILTY MEDICARE PROVIDER