Organization
MODERN SENIOR LIVING LLC
Active
Other names
SOUTH DALLAS NURSING AND REHABILITATION
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TROY P ISSAC (MANAGER)
(972) 669-1243
Entity
Organization
Contact information
Practice address
3808 S CENTRAL EXPY, DALLAS, TX 75215-3701
(214) 428-5851
Mailing address
4124 GUS THOMASSON ROAD, MESQUITE, TX 75150
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4607
—
TX
01
—
675440
MEDICARE PTAN
TX
Enumeration date
12/28/2010
Last updated
01/18/2021
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