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General NPI Number Information
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NPI Number | 1265683841
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Entity Type | Organization
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Legal Business Name | MANOR ASSISTED CARE LLC
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 6723 ATHA DR
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City | DALLAS
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State | TX
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Zip | 75217-5664
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Country | US
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Telephone | 214-490-6103
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Fax |
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Provider Business Mailing Address
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Address Line | 1472 N HAMPTON RD STE 111
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City | DESOTO
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State | TX
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Zip | 75115-3001
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Country | US
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Telephone | 972-224-4015
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Fax | 972-224-4339
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. KEITH POWELL
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Credential |
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Telephone | 972-224-4015
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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 | 123891
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License Number State | TX
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