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General NPI Number Information
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NPI Number | 1114171881
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Entity Type | Organization
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Legal Business Name | DAVENPORT RESIDENTIAL CARE HOME
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 1649 LCR 310
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City | MART
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State | TX
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Zip | 76664-5207
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Country | US
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Telephone | 254-344-2260
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Fax | 245-344-2472
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Provider Business Mailing Address
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Address Line | 1649 LCR 310
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City | MART
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State | TX
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Zip | 76664-5207
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Country | US
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Telephone | 254-344-2260
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Fax | 245-344-2472
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. NANCY ANN DAVENPORT
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Credential |
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Telephone | 254-344-2260
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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 | 000442
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License Number State | TX
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