Organization
TLC GP LLC
Active
Other names
COLONIAL RIDGE NURSING HOME
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS DEAPEN (SOLE MANAGER)
(214) 773-6000
Entity
Organization
Contact information
Practice address
1901 W ELLIOTT ST, BRECKENRIDGE, TX 76424-4001
(254) 559-3302
Mailing address
1901 W ELLIOTT ST, BRECKENRIDGE, TX 76424-4001
(254) 559-3302
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4255
—
TX
Enumeration date
02/09/2007
Last updated
08/22/2020
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