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General NPI Number Information
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NPI Number | 1528320520
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Entity Type | Organization
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Legal Business Name | FREEMAN'S ASSISTED LIVING LLC
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 500 CREEKTREE DR
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City | DESOTO
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State | TX
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Zip | 75115
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Country | US
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Telephone | 972-310-8741
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Fax | 888-817-8064
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Provider Business Mailing Address
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Address Line | PO BOX 1574
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone | 972-310-8741
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Fax | 888-817-8064
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Authorized Official
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Title or Position | MANAGER
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Name | NOLAN FREEMAN
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Credential | STATE LICENSED FACIL
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Telephone | 972-310-8741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 128061
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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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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