Basic Information
| Provider Information | |||||||||
| NPI: | 1801485537 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MSL DENISON LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 E US HIGHWAY 69 | ||||||||
| Address2: | |||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750216510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034652438 | ||||||||
| FaxNumber: | 9034633741 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E US HIGHWAY 69 | ||||||||
| Address2: | |||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750216510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034652438 | ||||||||
| FaxNumber: | 9034633741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2021 | ||||||||
| LastUpdateDate: | 01/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | ISSAC | ||||||||
| AuthorizedOfficialFirstName: | TROY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9034652438 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.