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Organization
MASON COPPELL OP LLC
Active
Organization
MASON COPPELL OP LLC
Active
Other names
Sandy Lake Rehabilitation and Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN D. HODGES (ADMINISTRATOR)
(972) 304-4444
Entity
Organization
Contact information
Practice address
1410 E SANDY LAKE RD, COPPELL, TX 75019-3119
(972) 304-4444
(972) 462-6605
Mailing address
1410 E SANDY LAKE RD, COPPELL, TX 75019-3119
(972) 304-4444
(972) 462-6605
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
131895
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001017901
—
TX
01
—
104250
FACILITY ID
TX
Enumeration date
11/05/2009
Last updated
08/02/2012
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