Provider Demographics
NPI:1770818478
Name:JSC LAKE HIGHLANDS OPERATIONS, LP
Entity Type:Organization
Organization Name:JSC LAKE HIGHLANDS OPERATIONS, LP
Other - Org Name:VILLAGES OF LAKE HIGHLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-899-4401
Mailing Address - Street 1:8615 LULLWATER DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4754
Mailing Address - Country:US
Mailing Address - Phone:214-221-0444
Mailing Address - Fax:
Practice Address - Street 1:8615 LULLWATER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4754
Practice Address - Country:US
Practice Address - Phone:214-221-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131077314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001018708Medicaid
TX676268Medicare Oscar/Certification