Provider Demographics
NPI:1376777391
Name:CSL LEASECO INC.
Entity Type:Organization
Organization Name:CSL LEASECO INC.
Other - Org Name:COVENANT PLACE OF BURLESON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPERTY CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:972-770-5600
Mailing Address - Street 1:611 NE ALSBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2658
Mailing Address - Country:US
Mailing Address - Phone:817-447-4477
Mailing Address - Fax:817-447-4505
Practice Address - Street 1:611 NE ALSBURY BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2658
Practice Address - Country:US
Practice Address - Phone:817-447-4477
Practice Address - Fax:817-447-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0384310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001017626Medicaid