# MODERN SENIOR LIVING LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTH DALLAS NURSING AND REHABILITATION
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346544855
- **Authorized official:** MR. TROY P ISSAC (MANAGER)
- **Authorized official phone:** (972) 669-1243

## Contact information

- **Practice address:** 3808 S CENTRAL EXPY, DALLAS, TX 75215-3701
- **Practice address phone:** (214) 428-5851
- **Mailing address:** 4124 GUS THOMASSON ROAD, MESQUITE, TX 75150

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 12/28/2010
- **Last updated:** 01/18/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4607 | — | TX |
| 01 | — | 675440 | MEDICARE PTAN | TX |