Basic Information
| Provider Information | |||||||||
| NPI: | 1972847242 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SLH MANSFIELD, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SLH MANSFIELD SNF LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 E WACKER DR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606013713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126734387 | ||||||||
| FaxNumber: | 3126734487 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E DEBBIE LN | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760639211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174533900 | ||||||||
| FaxNumber: | 8174533909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2012 | ||||||||
| LastUpdateDate: | 12/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | LEVY | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3126734387 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.