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General NPI Number Information
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NPI Number | 1528283280
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Entity Type | Organization
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Legal Business Name | TCG BENBROOK AL, LLC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 4242 BRYANT IRVIN RD COVENANT PLACE OF BURLESON, LP
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City | BENBROOK
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State | TX
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Zip | 76109-4222
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Country | US
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Telephone | 817-763-0088
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Fax | 817-763-8841
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Provider Business Mailing Address
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Address Line | 1200 SUMMIT AVE SUITE 444
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City | FORT WORTH
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State | TX
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Zip | 76102-4403
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Country | US
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Telephone | 817-446-4792
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Fax | 817-446-0923
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRYAN D. MCCALEB
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Credential |
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Telephone | 817-446-4792
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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 | 000619
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License Number State | TX
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