Organization
NEW HAVEN ASSISTED LIVING & MEMORY CARE
Active
Other names
65 Alive, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD NICHOLLS (REGIONAL PRESIDENT)
(847) 975-1609
Entity
Organization
Contact information
Practice address
107 CREEKSIDE TRL, KYLE, TX 78640-6261
(512) 400-0683
(512) 400-0684
Mailing address
107 CREEKSIDE TRL, KYLE, TX 78640-6261
(512) 400-0683
(512) 400-0684
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
140434
TX
311500000X
Alzheimer Center (Dementia Center)
140429/103276
TX
Other
Enumeration date
01/09/2015
Last updated
01/09/2015
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