Provider Demographics
NPI:1821508524
Name:ARBOR PARK SLC LLC
Entity Type:Organization
Organization Name:ARBOR PARK SLC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-412-4572
Mailing Address - Street 1:9119 ARBOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6131
Mailing Address - Country:US
Mailing Address - Phone:469-776-8943
Mailing Address - Fax:
Practice Address - Street 1:9119 ARBOR PARK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6131
Practice Address - Country:US
Practice Address - Phone:469-776-8943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-07
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging