MEDICARE: ASPEN LIVING CENTERS INC

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1649262411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN LIVING CENTERS INC

Provider Business Mailing Address
First Line	:	1415 W WASHINGTON ST
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78520-6549
Country	:	US
Telephone Number	:	956-546-3711
Fax Number	:	956-546-3799

Provider Business Practice Location Address
First Line	:	1415 W WASHINGTON ST
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78520-6549
Country	:	US
Telephone Number	:	956-546-3711
Fax Number	:	956-546-3799

Authorized Official
Title or Position	:	SECRETARY
Name	:	MICHAEL JAY BUMPASS
Credential	:	LNHA
Telephone Number	:	254-716-3616

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	01/21/2008

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