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General NPI Number Information
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NPI Number | 1003205618
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Entity Type | Organization
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Legal Business Name | NEW HAVEN ASSISTED LIVING AND MEMORY CARE
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 2300 FM 3009
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City | SCHERTZ
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State | TX
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Zip | 78154-2785
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Country | US
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Telephone | 210-319-4965
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Fax | 210-319-4947
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Provider Business Mailing Address
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Address Line | 2300 FM 3009
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City | SCHERTZ
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State | TX
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Zip | 78154-2785
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Country | US
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Telephone | 210-319-4965
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Fax | 210-319-4947
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Authorized Official
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Title or Position | REGIONAL PRESIDENT
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Name | RICHARD NICHOLLS
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Credential |
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Telephone | 847-975-1609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 105481
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 105480
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License Number State | TX
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