Organization
IMPERIAL ADULT CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAKWE BONGO MCDONALD (OWNER)
(214) 444-7406
Entity
Organization
Contact information
Practice address
1355 VENTURA DR, ROCKWALL, TX 75087-2492
(214) 444-7406
(469) 719-3685
Mailing address
1355 VENTURA DR, ROCKWALL, TX 75087-2492
(214) 444-7406
(469) 719-3685
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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