Organization
GOOD PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH JOHANNESSEN (PRESIDENT & COO)
(972) 770-5600
Entity
Organization
Contact information
Practice address
7801 N RICHLAND BLVD, NORTH RICHLAND HILLS, TX 76180-6415
(817) 581-6310
(817) 581-0608
Mailing address
14160 DALLAS PKWY, SUITE #300, DALLAS, TX 75254-4319
(972) 770-5600
(972) 770-5666
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
118540
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001014420
CBA CONTRACT #
TX
Enumeration date
09/29/2006
Last updated
06/18/2008
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