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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