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General NPI Number Information
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NPI Number | 1083583587
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Entity Type | Organization
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Legal Business Name | GOVERNORS RIDGE OPCO LLC
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 300 E DEVEREAUX ST
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City | DECATUR
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State | TX
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Zip | 76234-3075
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Country | US
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Telephone | 940-627-1104
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Fax |
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Provider Business Mailing Address
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Address Line | 2131 N COLLINS ST STE 433
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City | ARLINGTON
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State | TX
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Zip | 76011-2801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOE HAGAN
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Credential |
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Telephone | 636-226-7970
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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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