Provider Demographics
NPI:1871780924
Name:STRATEGIC CARE OF STEPHENVILLE, LLC
Entity type:Organization
Organization Name:STRATEGIC CARE OF STEPHENVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CWOCN
Authorized Official - Phone:817-808-7012
Mailing Address - Street 1:2309 W WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-3805
Mailing Address - Country:US
Mailing Address - Phone:254-968-4191
Mailing Address - Fax:254-968-0862
Practice Address - Street 1:2309 W WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3805
Practice Address - Country:US
Practice Address - Phone:254-968-4191
Practice Address - Fax:254-968-0862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRATEGIC MANAGEMENT GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-02
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005085314000000X
TX122400314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005085Medicaid
675242Medicare Oscar/Certification