- Enrollment id
- O20110617000635
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1346544855
- Multiple npi flag
- N
- Ccn
- 675440
- Associate id
- 0941488126
- Organization name
- MODERN SENIOR LIVING LLC
- Doing business as name
- SOUTH DALLAS NURSING AND REHABILITATION
- Incorporation date
- 2010-03-17
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SOUTH DALLAS NURSING & REHABILITATION
- Address line 1
- 3808 S CENTRAL EXPY
- City
- DALLAS
- State
- TX
- Zip code
- 752153701