Provider Demographics
NPI:1487642666
Name:SENIOR LIVING PROPERTIES LLC
Entity Type:Organization
Organization Name:SENIOR LIVING PROPERTIES LLC
Other - Org Name:GRAHAM LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-410-7300
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76099-1389
Mailing Address - Country:US
Mailing Address - Phone:817-410-7300
Mailing Address - Fax:817-810-7411
Practice Address - Street 1:1201 CHERRY ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-3829
Practice Address - Country:US
Practice Address - Phone:940-549-7513
Practice Address - Fax:940-549-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123571310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000149900Medicaid
TX000634OtherFACILITY ID NO.