MEDICARE: SAFE PLACES 2003LLC

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	:	1184885782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE PLACES 2003LLC

Provider Business Mailing Address
First Line	:	PO BOX 795545
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75379-5545
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7038 LATTIMORE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-6116
Country	:	US
Telephone Number	:	972-342-9783
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUNE WEISMER
Credential	:
Telephone Number	:	972-342-9783

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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