Provider Demographics
NPI:1780637967
Name:SLP HEARNE LLC
Entity Type:Organization
Organization Name:SLP HEARNE LLC
Other - Org Name:HEARNE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-410-7300
Mailing Address - Street 1:1300 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5737
Mailing Address - Country:US
Mailing Address - Phone:817-410-7300
Mailing Address - Fax:817-423-6270
Practice Address - Street 1:1101 W BROWN ST
Practice Address - Street 2:
Practice Address - City:HEARNE
Practice Address - State:TX
Practice Address - Zip Code:77859-3064
Practice Address - Country:US
Practice Address - Phone:979-279-5361
Practice Address - Fax:979-279-2457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2017-03-14
Deactivation Date:2006-05-25
Deactivation Code:
Reactivation Date:2006-12-08
Provider Licenses
StateLicense IDTaxonomies
TX116404314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004722OtherFACILITY ID NO.
TX675062Medicare Oscar/Certification
TX675062Medicare Oscar/Certification
TX004722OtherFACILITY ID NO.