Organization
ELCM JOHNSON CITY LEASING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL BOETHEL (PRINCIPAL)
(214) 535-6071
Entity
Organization
Contact information
Practice address
2111 E LAKEVIEW DR, JOHNSON CITY, TN 37601-1890
(423) 926-1292
Mailing address
14241 DALLAS PKWY, SUITE 650, BUILDING 3, DALLAS, TX 75254-2936
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
ACL0000000376
TN
Other
Enumeration date
08/26/2016
Last updated
08/26/2016
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