Healthcare Provider Details

I. General information

NPI: 1750559324
Provider Name (Legal Business Name): PREMIER COUNTRY HAVEN ASSISTED LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13812 HIRAM RD
WILLS POINT TX
75169-8652
US

IV. Provider business mailing address

13812 HIRAM RD
WILLS POINT TX
75169-8652
US

V. Phone/Fax

Practice location:
  • Phone: 214-729-9094
  • Fax: 800-878-1268
Mailing address:
  • Phone: 214-729-9094
  • Fax: 800-878-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANKLIN R. HUNTER
Title or Position: PRESIDENT
Credential:
Phone: 214-729-9094