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General NPI Number Information
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NPI Number | 1306653035
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Entity Type | Organization
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Legal Business Name | MINEOLA SENIOR LIVING, LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 135 AUTUMN WIND CT
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City | MINEOLA
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State | TX
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Zip | 75773-0018
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Country | US
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Telephone | 903-569-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 117 W MAIN ST
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City | ALLEN
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State | TX
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Zip | 75013-2763
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Country | US
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Telephone | 817-789-6157
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SCOTT LUNDY
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Credential |
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Telephone | 817-789-6157
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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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