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General NPI Number Information
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NPI Number | 1700256443
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Entity Type | Organization
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Legal Business Name | REAVIS ASSISTED LIVING LLC
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 101 TALLWOOD DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-8315
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Country | US
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Telephone | 512-948-7600
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Fax | 512-930-9122
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Provider Business Mailing Address
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Address Line | PO BOX 2479
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City | GEORGETOWN
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State | TX
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Zip | 78627-2479
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Country | US
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Telephone | 512-863-4094
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Fax | 512-930-9122
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Authorized Official
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Title or Position | CEO
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Name | CATHY SAUNDERS
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Credential |
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Telephone | 512-863-4094
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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 | 139171
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License Number State | TX
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