Provider Demographics
NPI:1568113785
Name:LSREFGOLDEN OPS 26 (TX) II, LLC
Entity Type:Organization
Organization Name:LSREFGOLDEN OPS 26 (TX) II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT FOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-673-4470
Mailing Address - Street 1:2709 CIMARRON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3431
Mailing Address - Country:US
Mailing Address - Phone:361-356-7864
Mailing Address - Fax:
Practice Address - Street 1:2709 CIMARRON BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3431
Practice Address - Country:US
Practice Address - Phone:361-356-7864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility