Provider Demographics
NPI:1619238425
Name:MASON MESQUITE OP, LLC
Entity Type:Organization
Organization Name:MASON MESQUITE OP, LLC
Other - Org Name:EDGEWOOD REHABILITATION AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:M.
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-341-2720
Mailing Address - Street 1:4949 WESTGROVE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1923
Mailing Address - Country:US
Mailing Address - Phone:469-341-2720
Mailing Address - Fax:
Practice Address - Street 1:1101 WINDBELL DRIVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:469-341-2720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility