LS Vernon Operator LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LS VERNON OPERATOR LLC

Doing business as

Willow Creek Healthcare Centre

Practice address

501 Yates St
Mount Vernon, TX 75457-3233

Phone

(903) 537-4424

Fax

(903) 537-3427

NPI assigned

Feb 6, 2019

Last updated

Oct 9, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Lazar

Title

Authorized Representative

Phone

(323) 651-1808

Specialties & licenses 1

Addresses

Other names 1

• Willow Creek Healthcare Centre Doing business as

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

{
    "created_epoch": "1549411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1821553595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 YATES ST",
            "city": "MOUNT VERNON",
            "state": "TX",
            "postal_code": "754573233",
            "telephone_number": "903-537-4424",
            "fax_number": "903-597-3427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 YATES ST",
            "city": "MOUNT VERNON",
            "state": "TX",
            "postal_code": "754573233",
            "telephone_number": "903-537-4424",
            "fax_number": "903-537-3427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LS VERNON OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-06",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A",
        "authorized_official_last_name": "LAZAR",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "323-651-1808"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Creek Healthcare Centre",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lance M Potter PLLC
• Jean Woel Latortue, MD
• Madilyne Marie Logan, M.S., CF-SLP
• Karolena Lopez-Prado, APRN
• Mason Lowery
• Jeffrey Wayne Mannis, D.C.
• Brianna Martinez Melendez, PA-C
• McKenna Medders, ATC
• Medicine Chest Medical Supply, Inc. (Medicine Chest Medical Supply of Mt. Vernon)
• Medlife Pharmacy

• Skilled Nursing Facility in Mount Vernon, TX
• Providers in Mount Vernon, 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 9, 2020; 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.