Organization
21ST CENTURY LIVING CENTERS
Active
Other names
BROOKWOOD III
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE DEANNE NEAL (ADMIN/ASSISTANT QMRP)
(817) 481-5368
Entity
Organization
Contact information
Practice address
2410 TAYLOR ST, SOUTHLAKE, TX 76092-3316
(817) 424-3338
Mailing address
2695 LONESOME DOVE RD, SOUTHLAKE, TX 76092-3223
(817) 481-5368
(817) 251-0318
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
000762301
TX
Other
Enumeration date
08/09/2007
Last updated
08/09/2007
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