Provider Demographics
NPI:1407318546
Name:LS SAN SABA OPERATOR LLC
Entity Type:Organization
Organization Name:LS SAN SABA OPERATOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-651-1808
Mailing Address - Street 1:6300 WILSHIRE BLVD STE 1800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5236
Mailing Address - Country:US
Mailing Address - Phone:323-651-1808
Mailing Address - Fax:
Practice Address - Street 1:1405 W STOREY ST
Practice Address - Street 2:
Practice Address - City:SAN SABA
Practice Address - State:TX
Practice Address - Zip Code:76877-6422
Practice Address - Country:US
Practice Address - Phone:325-372-5112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility