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General NPI Number Information
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NPI Number | 1235681594
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Entity Type | Organization
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Legal Business Name | MASON'S PERSONAL CARE HOMES #2
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 10451 SUMMER OAKS DR
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City | DALLAS
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State | TX
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Zip | 75227-7681
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Country | US
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Telephone | 214-235-3076
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Fax |
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Provider Business Mailing Address
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Address Line | 10451 SUMMER OAKS DR
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City | DALLAS
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State | TX
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Zip | 75227-7681
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Country | US
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Telephone | 214-235-3076
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BORIS EARL MASON
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Credential |
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Telephone | 214-235-3076
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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 | 119220
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License Number State | TX
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