Provider Demographics
NPI:1447967021
Name:MESQUITE SENIOR CARE LLC
Entity type:Organization
Organization Name:MESQUITE SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-883-7920
Mailing Address - Street 1:900 WIGGINS PKWY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1400
Mailing Address - Country:US
Mailing Address - Phone:972-686-2439
Mailing Address - Fax:866-218-4678
Practice Address - Street 1:900 WIGGINS PKWY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1400
Practice Address - Country:US
Practice Address - Phone:972-686-2439
Practice Address - Fax:866-218-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation