Organization
LS VERNON OPERATOR LLC
Active
Other names
Willow Creek Healthcare Centre
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LAZAR (AUTHORIZED REPRESENTATIVE)
(323) 651-1808
Entity
Organization
Contact information
Practice address
501 YATES ST, MOUNT VERNON, TX 75457-3233
(903) 537-4424
(903) 537-3427
Mailing address
501 YATES ST, MOUNT VERNON, TX 75457-3233
(903) 537-4424
(903) 597-3427
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
02/06/2019
Last updated
10/09/2020
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