Basic Information
| Provider Information | |||||||||
| NPI: | 1235126103 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SENIOR HEALTH - MEADOWBROOK, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEADOWBROOK NURSING AND REHAB CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 307 | ||||||||
| Address2: | |||||||||
| City: | VAN ALSTYNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754950307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034826455 | ||||||||
| FaxNumber: | 9034826048 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 WINDSOR DR. | ||||||||
| Address2: | |||||||||
| City: | VAN ALSTYNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754950307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034826455 | ||||||||
| FaxNumber: | 9034826048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SNOW | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL CASE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9724102600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 675151 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.