MEDICARE: FREEMAN'S ASSISTED LIVING FACILITY

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	:	1508287053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEMAN'S ASSISTED LIVING FACILITY

Provider Business Mailing Address
First Line	:	PO BOX 1574
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-0009
Country	:	US
Telephone Number	:	972-310-8741
Fax Number	:	888-817-8064

Provider Business Practice Location Address
First Line	:	2711 MCDANIEL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-8107
Country	:	US
Telephone Number	:	972-310-8741
Fax Number	:	888-817-8064

Authorized Official
Title or Position	:	OWNER
Name	:	NOLAN FREEMAN
Credential	:
Telephone Number	:	972-310-8741

Provider Enumeration Date	:	01/01/2014
Last Update Date	:	01/01/2014

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