Provider Demographics
NPI:1881682433
Name:SENIOR LIVING PROPERTIES LLC
Entity Type:Organization
Organization Name:SENIOR LIVING PROPERTIES LLC
Other - Org Name:KERMIT HEALTHCARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-410-7300
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76099-1389
Mailing Address - Country:US
Mailing Address - Phone:817-410-7300
Mailing Address - Fax:817-810-7411
Practice Address - Street 1:2000 E SCHOOL ST
Practice Address - Street 2:
Practice Address - City:KERMIT
Practice Address - State:TX
Practice Address - Zip Code:79745-5205
Practice Address - Country:US
Practice Address - Phone:432-586-6665
Practice Address - Fax:432-586-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122531314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004877OtherFACILITY ID NO.
TX004877OtherFACILITY ID NO.
TX67-5015Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER