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General NPI Number Information
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NPI Number | 1639224223
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Entity Type | Organization
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Legal Business Name | CHISHOLM TRAIL ESTATES, INC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 513 S OLD BETSY RD
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City | KEENE
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State | TX
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Zip | 76059-1414
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Country | US
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Telephone | 817-556-9100
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Fax | 817-556-0742
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Provider Business Mailing Address
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Address Line | 513 S OLD BETSY RD
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City | KEENE
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State | TX
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Zip | 76059-1414
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Country | US
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Telephone | 817-556-9100
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Fax | 817-556-0742
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. HERBERT C HOUSER
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Credential |
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Telephone | 817-556-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 117811
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License Number State | TX
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