Provider Demographics
NPI:1790399525
Name:SPRINGFIELD SENIOR LIVING LLC
Entity Type:Organization
Organization Name:SPRINGFIELD SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEJOY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-287-5053
Mailing Address - Street 1:1817 ROYAL CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1023
Mailing Address - Country:US
Mailing Address - Phone:214-501-2025
Mailing Address - Fax:214-593-3235
Practice Address - Street 1:1817 ROYAL CREST DRIVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1023
Practice Address - Country:US
Practice Address - Phone:214-501-2025
Practice Address - Fax:214-593-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility