Provider Demographics
NPI:1346304094
Name:SENIOR LIVING PROPERTIES LLC
Entity Type:Organization
Organization Name:SENIOR LIVING PROPERTIES LLC
Other - Org Name:COLEMAN HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:972-989-5024
Mailing Address - Street 1:1111 S MAIN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5577
Mailing Address - Country:US
Mailing Address - Phone:817-865-5069
Mailing Address - Fax:817-329-2124
Practice Address - Street 1:2713 SOUTH COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834
Practice Address - Country:US
Practice Address - Phone:325-623-4105
Practice Address - Fax:325-625-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116127314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675004Medicare ID - Type Unspecified