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General NPI Number Information
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NPI Number | 1073837589
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Entity Type | Organization
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Legal Business Name | ATRIA GRAPEVINE
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 3975 WILLIAM D TATE AVE
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City | GRAPEVINE
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State | TX
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Zip | 76051-7109
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Country | US
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Telephone | 817-416-8907
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Fax | 817-421-9792
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Provider Business Mailing Address
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Address Line | 3975 WILLIAM D TATE AVE
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City | GRAPEVINE
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State | TX
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Zip | 76051-7109
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Country | US
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Telephone | 817-416-8907
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Fax | 817-421-9792
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. BILLY RAY REDMON JR.
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Credential |
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Telephone | 817-416-8907
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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 | 030384
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License Number State | TX
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