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General NPI Number Information
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NPI Number | 1851509632
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Entity Type | Organization
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Legal Business Name | LENROSE PLACE
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5395 ROSE LN
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City | BEAUMONT
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State | TX
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Zip | 77708-2911
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Country | US
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Telephone | 409-347-2497
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Fax | 409-892-4199
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Provider Business Mailing Address
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Address Line | 5395 ROSE LN
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City | BEAUMONT
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State | TX
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Zip | 77708-2911
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Country | US
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Telephone | 409-347-2497
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Fax | 409-892-4199
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Authorized Official
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Title or Position | MANAGER
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Name | MR. REYNALDO CRUZ MEDINA
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Credential |
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Telephone | 409-363-4171
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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 | 119564
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License Number State | TX
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