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NPI Code Detail

MEDICARE: JCS LAKE HIGHLANDS OPERATIONS LP

MEDICARE: JCS LAKE HIGHLANDS OPERATIONS LP
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
1311500000XAlzheimer Center (Dementia Center)TX
2310400000XAssisted Living FacilityTX

General Provider Information

NPI Number : 1265769582
Entity Type Code : Organization
Provider Name (Legal Business Name) : JCS LAKE HIGHLANDS OPERATIONS LP
Provider Business Mailing Address
First Line : 1500 WATERS RIDGE DR
Second Line :
City : LEWISVILLE
State : TX
Zip : 75057-6011
Country : US
Telephone Number : 972-899-4401
Fax Number :
Provider Business Practice Location Address
First Line : 8615 LULLWATER DR
Second Line :
City : DALLAS
State : TX
Zip : 75238-4754
Country : US
Telephone Number : 214-221-0444
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICER
Name : PAULA PIERCE
Credential :
Telephone Number : 972-899-4401
Provider Enumeration Date : 11/06/2009
Last Update Date : 01/06/2010

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