Provider Demographics
NPI:1902185903
Name:HARBOR LAKES SCC LLC
Entity Type:Organization
Organization Name:HARBOR LAKES SCC LLC
Other - Org Name:HARBOR LAKES NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-252-7600
Mailing Address - Street 1:14841 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7685
Mailing Address - Country:US
Mailing Address - Phone:214-252-7600
Mailing Address - Fax:214-252-7704
Practice Address - Street 1:1300 E 2ND ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1496
Practice Address - Country:US
Practice Address - Phone:817-408-3800
Practice Address - Fax:817-573-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001019881Medicaid
TX676185Medicare Oscar/Certification