Provider Demographics
NPI:1235126103
Name:SENIOR HEALTH - MEADOWBROOK, LLC
Entity Type:Organization
Organization Name:SENIOR HEALTH - MEADOWBROOK, LLC
Other - Org Name:MEADOWBROOK NURSING AND REHAB CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-410-2600
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-0307
Mailing Address - Country:US
Mailing Address - Phone:903-482-6455
Mailing Address - Fax:903-482-6048
Practice Address - Street 1:100 WINDSOR DR.
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-0307
Practice Address - Country:US
Practice Address - Phone:903-482-6455
Practice Address - Fax:903-482-6048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675151314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675151Medicare ID - Type Unspecified