Healthcare Provider Details

I. General information

NPI: 1003142944
Provider Name (Legal Business Name): ESC IV, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 L DON DODSON DR
BEDFORD TX
76021-5788
US

IV. Provider business mailing address

6737 W WASHINGTON ST STE 2300
MILWAUKEE WI
53214-5650
US

V. Phone/Fax

Practice location:
  • Phone: 817-267-6200
  • Fax:
Mailing address:
  • Phone: 414-918-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number010265
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number010265
License Number StateTX

VIII. Authorized Official

Name: JOANNE LESKOWICZ
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 414-918-5000