Provider Demographics
NPI:1043585615
Name:JACK HENRY ARLINGTON, LLC
Entity Type:Organization
Organization Name:JACK HENRY ARLINGTON, LLC
Other - Org Name:MEADOWBROOK MEMORY CARE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMETT
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:KOELSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-867-1900
Mailing Address - Street 1:111 MARKET ST NE STE 200
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1008
Mailing Address - Country:US
Mailing Address - Phone:360-867-1900
Mailing Address - Fax:360-867-1956
Practice Address - Street 1:2300 LITTLE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016
Practice Address - Country:US
Practice Address - Phone:817-451-9700
Practice Address - Fax:817-451-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)