# MASON COPPELL OP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sandy Lake Rehabilitation and Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568799914
- **Authorized official:** MARILYN D. HODGES (ADMINISTRATOR)
- **Authorized official phone:** (972) 304-4444

## Contact information

- **Practice address:** 1410 E SANDY LAKE RD, COPPELL, TX 75019-3119
- **Practice address phone:** (972) 304-4444
- **Practice address fax:** (972) 462-6605
- **Mailing address:** 1410 E SANDY LAKE RD, COPPELL, TX 75019-3119
- **Mailing address phone:** (972) 304-4444
- **Mailing address fax:** (972) 462-6605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 131895 | TX | Yes |

## Other

- **Enumeration date:** 11/05/2009
- **Last updated:** 08/02/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001017901 | — | TX |
| 01 | — | 104250 | FACILITY ID | TX |