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General NPI Number Information
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NPI Number | 1205964640
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Entity Type | Organization
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Legal Business Name | ESC III LP
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 4415 RIO D ORO
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City | SAN ANTONIO
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State | TX
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Zip | 78233-6748
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Country | US
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Telephone | 210-653-3132
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Fax | 210-653-9791
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Provider Business Mailing Address
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Address Line | 6737 W WASHINGTON ST SUITE 2300
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City | MILWAUKEE
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State | WI
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Zip | 53214-5647
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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 | EVP, CHIEF ADMIN. OFFICER
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Name | BRYAN RICHARDSON
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Credential |
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Telephone | 615-564-8131
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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 | 117213
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License Number State | TX
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