Provider Demographics
NPI:1841509015
Name:BRYAN SNF, LLC
Entity type:Organization
Organization Name:BRYAN SNF, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:4091 EASTCHESTER DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4732
Practice Address - Country:US
Practice Address - Phone:979-774-3401
Practice Address - Fax:979-774-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility