Organization
ESC IV LP
Active
Other names
Brookdale South San Angelo
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN RICHARDSON (EVP, CHIEF ADMIN. OFFICER)
(615) 564-8131
Entity
Organization
Contact information
Practice address
2695 VALLEYVIEW BLVD, SAN ANGELO, TX 76904-3523
(325) 947-7194
(325) 223-8144
Mailing address
6737 W WASHINGTON ST, SUITE 2300, MILWAUKEE, WI 53214-5647
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
119055
TX
311500000X
Alzheimer Center (Dementia Center)
119055
TX
Other
Enumeration date
04/26/2007
Last updated
05/18/2016
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