Basic Information
| Provider Information | |||||||||
| NPI: | 1346419397 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENIOR CARE RESOURCES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SENIOR CARE HEALTH & REHABILITATION CENTER-DECATUR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1413 E INTERSTATE 30 STE 7 | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750434598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723037500 | ||||||||
| FaxNumber: | 9723039700 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 BENNETT RD | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762343817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9406262800 | ||||||||
| FaxNumber: | 9723039992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2008 | ||||||||
| LastUpdateDate: | 01/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | SHANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/CFO | ||||||||
| AuthorizedOfficialTelephone: | 9723037500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001016444 | 05 | TX | MEDICAID |