Provider Demographics
NPI:1407389075
Name:SAL 2016 LLC
Entity Type:Organization
Organization Name:SAL 2016 LLC
Other - Org Name:LONG CREEK ASSISTED LIVING AND MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:817-386-8888
Mailing Address - Street 1:3973 W VICKERY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6492
Mailing Address - Country:US
Mailing Address - Phone:817-386-8888
Mailing Address - Fax:817-386-8324
Practice Address - Street 1:301 T. C. LUPTON BLVD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182
Practice Address - Country:US
Practice Address - Phone:469-563-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility