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General NPI Number Information
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NPI Number | 1104120930
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Entity Type | Organization
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Legal Business Name | LUCRESSA ASSISTED LIVING
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 2314 S EWING AVE
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City | DALLAS
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State | TX
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Zip | 75216-2423
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Country | US
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Telephone | 972-217-9297
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Fax | 972-230-2832
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Provider Business Mailing Address
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Address Line | 2314 SOUTH EWING AVE
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City | DALLAS
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State | TX
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Zip | 75216
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Country | US
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Telephone | 972-217-9297
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Fax | 972-230-2832
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Authorized Official
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Title or Position | PARTNER
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Name | MR. LEON WRIGHT
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Credential |
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Telephone | 972-217-9297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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