Provider Demographics
NPI:1659885143
Name:S J LARRY PROPERTIES, LLC
Entity Type:Organization
Organization Name:S J LARRY PROPERTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-200-5267
Mailing Address - Street 1:17740 PRESTON RD STE 200D
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5840
Mailing Address - Country:US
Mailing Address - Phone:214-200-5267
Mailing Address - Fax:
Practice Address - Street 1:17740 PRESTON RD STE 200D
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5840
Practice Address - Country:US
Practice Address - Phone:214-200-5267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty