MEDICARE: ALF HOME OF HOPE 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	128685	TX

General Provider Information

NPI Number	:	1568752525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALF HOME OF HOPE LLC

Provider Business Mailing Address
First Line	:	1449 ALDRIDGE DR
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75134-2966
Country	:	US
Telephone Number	:	469-939-0124
Fax Number	:

Provider Business Practice Location Address
First Line	:	2539 KIRKLEY ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-4872
Country	:	US
Telephone Number	:	214-372-1492
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANGELA PROX
Credential	:
Telephone Number	:	469-939-0124

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	12/03/2014

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