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General NPI Number Information
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NPI Number | 1598314619
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Entity Type | Organization
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Legal Business Name | ELDORADO WEST SENIOR LIVING
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 3051 W ELDORADO PKWY
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City | LITTLE ELM
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State | TX
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Zip | 75068-3537
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Country | US
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Telephone | 469-777-3151
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Fax | 972-307-5385
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Provider Business Mailing Address
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Address Line | 6628 MYRTLE BEACH DR
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City | PLANO
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State | TX
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Zip | 75093-6302
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Country | US
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Telephone | 214-718-1120
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Fax | 972-307-5385
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Authorized Official
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Title or Position | MANAGER
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Name | CHAN YOUNG PARK
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Credential |
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Telephone | 214-718-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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