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General NPI Number Information
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NPI Number | 1134754989
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Entity Type | Organization
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Legal Business Name | STEWART BATTLE SAFE HAVEN
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 504 BOB WHITE ST
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City | DESOTO
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State | TX
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Zip | 75115-5089
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Country | US
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Telephone | 972-748-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 832 VINCE LN
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City | DESOTO
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State | TX
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Zip | 75115-4410
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Country | US
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Telephone | 678-451-7879
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PENNY BETTY KING
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Credential |
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Telephone | 678-451-7879
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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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