Provider Demographics
NPI:1467987610
Name:SLP KNOX CITY LLC
Entity Type:Organization
Organization Name:SLP KNOX CITY LLC
Other - Org Name:BRAZOS VALLEY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-410-7300
Mailing Address - Street 1:1300 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5737
Mailing Address - Country:US
Mailing Address - Phone:817-410-7300
Mailing Address - Fax:
Practice Address - Street 1:605 S AVENUE F
Practice Address - Street 2:
Practice Address - City:KNOX CITY
Practice Address - State:TX
Practice Address - Zip Code:79529-2103
Practice Address - Country:US
Practice Address - Phone:940-658-3543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility