Provider Demographics
NPI:1922309962
Name:MANSFIELD SNF LLC
Entity Type:Organization
Organization Name:MANSFIELD SNF LLC
Other - Org Name:ISLE AT WATERCREST - MANSFIELD, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:WILLARD
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:214-370-2600
Mailing Address - Street 1:5307 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5109
Mailing Address - Country:US
Mailing Address - Phone:214-370-2600
Mailing Address - Fax:214-370-2699
Practice Address - Street 1:200 E. DEBBIE LANE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-453-3900
Practice Address - Fax:817-453-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility