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General NPI Number Information
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NPI Number | 1568890820
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Entity Type | Organization
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Legal Business Name | IND HALL LLC
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 1210 JACKSON ST
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City | BOWIE
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State | TX
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Zip | 76230-3034
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Country | US
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Telephone | 940-872-9718
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Fax | 940-872-8590
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Provider Business Mailing Address
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Address Line | 1210 JACKSON ST
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City | BOWIE
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State | TX
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Zip | 76230-3034
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Country | US
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Telephone | 940-872-9718
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Fax | 940-872-8590
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Authorized Official
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Title or Position | OWNER
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Name | JON R EVANS
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Credential |
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Telephone | 817-475-0409
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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 | 133835
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License Number State | TX
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