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General NPI Number Information
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NPI Number | 1699012518
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Entity Type | Organization
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Legal Business Name | MAJESTIC SENIOR LIVING HASKELL LLC
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 1302 N 1ST ST
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City | HASKELL
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State | TX
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Zip | 79521-5434
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Country | US
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Telephone | 940-864-2727
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Fax | 940-864-2850
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Provider Business Mailing Address
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Address Line | 2323 TOWNEHEIGHTS TER SE
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City | SMYRNA
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State | GA
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Zip | 30080-7408
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Country | US
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Telephone | 352-222-0417
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Fax | 352-433-4077
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Authorized Official
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Title or Position | MANAGER
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Name | BRUCE ABDUL
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Credential |
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Telephone | 352-222-0417
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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 |
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