Provider Demographics
NPI:1942695242
Name:GROOM TRANSITIONAL CARE LLC
Entity Type:Organization
Organization Name:GROOM TRANSITIONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LOVELACE
Authorized Official - Last Name:GROOM
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:214-707-0273
Mailing Address - Street 1:2435 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 890
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2753
Mailing Address - Country:US
Mailing Address - Phone:214-707-0273
Mailing Address - Fax:
Practice Address - Street 1:401 W CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3416
Practice Address - Country:US
Practice Address - Phone:214-707-0273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility