MEDICARE: ESL BRAESWOOD OPERATIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1295011930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESL BRAESWOOD OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	9510 ORMSBY STATION RD
Second Line	:	SUITE 101 ATTENTION LEGAL DEPARTMENT
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4081
Country	:	US
Telephone Number	:	502-753-6004
Fax Number	:	502-753-6104

Provider Business Practice Location Address
First Line	:	2555 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2827
Country	:	US
Telephone Number	:	713-839-8265
Fax Number	:	713-664-9495

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ROBIN L. BARBER
Credential	:	JD
Telephone Number	:	502-753-6004

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	10/26/2011

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