Provider Demographics
NPI:1033665492
Name:ELCM OAK RIDGE LEASING LLC
Entity Type:Organization
Organization Name:ELCM OAK RIDGE LEASING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-535-6071
Mailing Address - Street 1:14241 DALLAS PKWY
Mailing Address - Street 2:SUITE 650, BUILDING 3
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2936
Mailing Address - Country:US
Mailing Address - Phone:973-219-6873
Mailing Address - Fax:
Practice Address - Street 1:300 BRIARCLIFF AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8731
Practice Address - Country:US
Practice Address - Phone:865-481-6009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000346311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home