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General NPI Number Information
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NPI Number | 1588806798
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Entity Type | Organization
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Legal Business Name | LANE'S ASSISTED LIVING FACILITY LLC
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 2617 CAROLINA DR
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City | FORT WORTH
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State | TX
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Zip | 76123-1661
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Country | US
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Telephone | 817-689-0125
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Fax |
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Provider Business Mailing Address
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Address Line | 4937 MADYSON RIDGE DR
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City | FORT WORTH
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State | TX
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Zip | 76133-3847
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Country | US
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Telephone | 817-690-9307
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. TOLECHIA V LANE
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Credential |
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Telephone | 817-690-9307
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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 | TX
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