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General NPI Number Information
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NPI Number | 1689782724
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Entity Type | Organization
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Legal Business Name | DOUBLE VISION
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 110 OUTLET DR
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City | HILLSBORO
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State | TX
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Zip | 76645-2752
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Country | US
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Telephone | 254-582-0030
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Fax | 254-580-1608
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Provider Business Mailing Address
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Address Line | 9112 CAMP BOWIE W # 222
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City | FORT WORTH
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State | TX
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Zip | 76116-6099
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Country | US
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Telephone | 817-249-2300
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Fax | 817-249-4300
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Authorized Official
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Title or Position | SENIOR ASSET MANAGER
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Name | MS. LAURA R TAYLOR
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Credential |
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Telephone | 817-249-2300
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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 | 116891
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License Number State | TX
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