Provider Demographics
NPI:1174694293
Name:SILVERLEAF HEALTHCARE SYSTEMS INC
Entity type:Organization
Organization Name:SILVERLEAF HEALTHCARE SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:817-633-7787
Mailing Address - Street 1:1201 N WATSON RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6190
Mailing Address - Country:US
Mailing Address - Phone:817-633-7787
Mailing Address - Fax:817-633-7781
Practice Address - Street 1:1201 N WATSON RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6190
Practice Address - Country:US
Practice Address - Phone:817-633-7787
Practice Address - Fax:817-633-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5239480001Medicare ID - Type Unspecified