| NPI | 1124435847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS T TABENYANG President 469-605-7229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3140N1450X Skilled Nursing Facility, Nursing Care, Pediatric |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: TX 801958052) | |
| 313M00000X Nursing Facility/Intermediate Care Facility | |
| 314000000X Skilled Nursing Facility | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-07-15 |