Healthcare Provider Details

I. General information

NPI: 1598160715
Provider Name (Legal Business Name): PF LW ALF OPS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3494 KINGBRIDGE STREET
DALLAS TX
75212
US

IV. Provider business mailing address

1500 WATERS RIDGE DR
LEWISVILLE TX
75057-6011
US

V. Phone/Fax

Practice location:
  • Phone: 972-899-4401
  • Fax:
Mailing address:
  • Phone: 972-899-4401
  • Fax: 972-899-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number142829
License Number StateTX

VIII. Authorized Official

Name: JAMES M CHANCE
Title or Position: PRESIDENT & CEO
Credential:
Phone: 214-725-2837