Provider Demographics
NPI:1235357583
Name:SILVER CREEK PLACE LTD.
Entity Type:Organization
Organization Name:SILVER CREEK PLACE LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:HETTICK
Authorized Official - Suffix:
Authorized Official - Credentials:BS , MS IN ED
Authorized Official - Phone:817-300-7346
Mailing Address - Street 1:1300 SILVER CREEK AZLE RD
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3844
Mailing Address - Country:US
Mailing Address - Phone:817-238-8126
Mailing Address - Fax:
Practice Address - Street 1:1300 SILVER CREEK AZLE RD
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3844
Practice Address - Country:US
Practice Address - Phone:817-238-8126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120021310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility