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General NPI Number Information
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NPI Number | 1013805803
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Entity Type | Organization
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Legal Business Name | 2345 MANOR DR ALF OPCO LLC
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 2345 MANOR DR
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City | BRYAN
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State | TX
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Zip | 77802-1908
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Country | US
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Telephone | 979-821-7300
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Fax | 979-821-7301
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Provider Business Mailing Address
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Address Line | 2345 MANOR DR
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City | BRYAN
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State | TX
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Zip | 77802-1908
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Country | US
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Telephone | 979-821-7300
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Fax | 979-821-7301
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Authorized Official
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Title or Position | MANAGER
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Name | NOCHUM FREUND
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Credential |
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Telephone | 732-719-5098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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