Provider Demographics
NPI:1255329892
Name:SENIOR LIVING PROPERTIES
Entity Type:Organization
Organization Name:SENIOR LIVING PROPERTIES
Other - Org Name:ANSON HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:TAL
Authorized Official - Last Name:TUMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-823-3471
Mailing Address - Street 1:125 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:ANSON
Mailing Address - State:TX
Mailing Address - Zip Code:79501-2113
Mailing Address - Country:US
Mailing Address - Phone:325-823-3471
Mailing Address - Fax:325-823-2621
Practice Address - Street 1:125 AVENUE J
Practice Address - Street 2:
Practice Address - City:ANSON
Practice Address - State:TX
Practice Address - Zip Code:79501-2113
Practice Address - Country:US
Practice Address - Phone:325-823-3471
Practice Address - Fax:325-823-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110462314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX440406Medicaid
TX440406Medicaid