Provider Demographics
NPI:1992858823
Name:APOLLO LEASING LLC
Entity Type:Organization
Organization Name:APOLLO LEASING LLC
Other - Org Name:MCLEAN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-355-4957
Mailing Address - Street 1:1001 CROSS TIMBERS RD
Mailing Address - Street 2:SUITE 2275
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1371
Mailing Address - Country:US
Mailing Address - Phone:972-355-4957
Mailing Address - Fax:
Practice Address - Street 1:605 W. 7TH STREET
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:TX
Practice Address - Zip Code:79057
Practice Address - Country:US
Practice Address - Phone:805-779-2469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005156314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility