Provider Demographics
NPI:1205454089
Name:SH OPCO BURLESON LLC
Entity type:Organization
Organization Name:SH OPCO BURLESON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-308-8391
Mailing Address - Street 1:14160 DALLAS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-4383
Mailing Address - Country:US
Mailing Address - Phone:972-308-8391
Mailing Address - Fax:
Practice Address - Street 1:611 NE ALSBURY BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2658
Practice Address - Country:US
Practice Address - Phone:817-447-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147863OtherTEXAS HELATH AND HUMAN SERVICES