Provider Demographics
NPI:1912441767
Name:SILVERADO HERMANN PARK, LLC
Entity Type:Organization
Organization Name:SILVERADO HERMANN PARK, LLC
Other - Org Name:SILVERADO HERMANN PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEETSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-240-7200
Mailing Address - Street 1:6400 OAK CYN
Mailing Address - Street 2:200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-5203
Mailing Address - Country:US
Mailing Address - Phone:949-240-7200
Mailing Address - Fax:949-240-7270
Practice Address - Street 1:5600 CHENEVERT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7228
Practice Address - Country:US
Practice Address - Phone:713-521-0169
Practice Address - Fax:713-521-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility