Organization
COVENANT PLACE OF WAXAHACHIE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH JOHANNESSEN (PRESIDENT & COO)
(972) 770-5600
Entity
Organization
Contact information
Practice address
401 SOLON RD, WAXAHACHIE, TX 75165-1328
(972) 935-9363
(972) 923-3289
Mailing address
14160 DALLAS PKWY, SUITE 300, DALLAS, TX 75254-4319
(972) 770-5600
(972) 770-5666
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
117586
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001014421
CBA CONTRACT #
TX
05
—
001015630
—
TX
Enumeration date
09/29/2006
Last updated
03/08/2012
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