1350 E. Lookout Drive Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

145038 Issued in TX

Legal business name

1350 E. LOOKOUT DRIVE OPERATIONS LLC

Practice address

1350 E Lookout Dr
Richardson, TX 75082-4106

Phone

(972) 220-2000

NPI assigned

Mar 27, 2015

Organization subpart

Yes

Parent organization

GENESIS TX HOLDINGS LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael T. Berg

Title

Assistant Secretary

Phone

(505) 468-4752

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PowerBack Rehabilitation Richardson Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508803200000",
    "number": "1295129146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 E LOOKOUT DR",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750824106",
            "telephone_number": "972-220-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 E LOOKOUT DR",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750824106",
            "telephone_number": "972-220-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1350 E. LOOKOUT DRIVE OPERATIONS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS TX HOLDINGS LLC",
        "enumeration_date": "2015-03-27",
        "last_updated": "2017-10-24",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "145038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001026954",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PowerBack Rehabilitation Richardson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Richardson, TX
• Providers in Richardson, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.