MEDICARE: TERESA'S HOUSE - CRAIG RANCH, 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	:	1528769965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERESA'S HOUSE - CRAIG RANCH, LLC

Provider Business Mailing Address
First Line	:	6521 COLLIN MCKINNEY PKWY
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-2726
Country	:	US
Telephone Number	:	817-925-1173
Fax Number	:

Provider Business Practice Location Address
First Line	:	6521 COLLIN MCKINNEY PKWY
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-2726
Country	:	US
Telephone Number	:	817-925-1173
Fax Number	:

Authorized Official
Title or Position	:	RN - MANAGING PARTNER
Name	:	MRS. TERESA LYNN WHITTINGTON
Credential	:	RN
Telephone Number	:	817-925-1173

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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