Provider Demographics
NPI: | 1972094803 |
---|---|
Name: | LOH OPS GRAND SALINE LLC |
Entity Type: | Organization |
Organization Name: | LOH OPS GRAND SALINE LLC |
Other - Org Name: | ANDERSON NURSING CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOSHUA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LEONARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 404-556-7052 |
Mailing Address - Street 1: | 2830 S HULEN ST STE 382 |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT WORTH |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76109-1514 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 404-556-7052 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 520 BRADBURN RD |
Practice Address - Street 2: | |
Practice Address - City: | GRAND SALINE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75140-2015 |
Practice Address - Country: | US |
Practice Address - Phone: | 903-962-4234 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-05-26 |
Last Update Date: | 2018-05-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 314000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |