MEDICARE: SW AUSTIN ASSISTED LIVING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1033504980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SW AUSTIN ASSISTED LIVING, LLC

Provider Business Mailing Address
First Line	:	3801 HULEN ST
Second Line	:	SUITE 202
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7202
Country	:	US
Telephone Number	:	817-386-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	7501 WEST HIGHWAY 290
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736
Country	:	US
Telephone Number	:	512-288-8300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAWRENCE WAYNE POWELL JR.
Credential	:
Telephone Number	:	817-386-8888

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	03/30/2015

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