# HOLLAND LAKE SCC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Holland Lake Nursing & Rehab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790157519
- **Authorized official:** MICHAEL TEMPLETON (CHIEF OPERATIONS OFFICER)
- **Authorized official phone:** (214) 252-7600

## Contact information

- **Practice address:** 1201 HOLLAND LAKE DR, WEATHERFORD, TX 76086-5851
- **Practice address phone:** (817) 598-0160
- **Mailing address:** 14841 DALLAS PKWY, DALLAS, TX 75254-7685
- **Mailing address phone:** (214) 252-7600

## Taxonomy

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

## Other

- **Enumeration date:** 10/21/2015
- **Last updated:** 03/16/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001027377 | — | TX |