Provider Demographics
NPI:1043649221
Name:MOUNT PLEASANT ALF OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:MOUNT PLEASANT ALF OPERATING COMPANY LLC
Other - Org Name:MT PLEASANT ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR AR
Authorized Official - Prefix:
Authorized Official - First Name:KELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-467-5728
Mailing Address - Street 1:2009 N EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2010
Mailing Address - Country:US
Mailing Address - Phone:903-572-8123
Mailing Address - Fax:
Practice Address - Street 1:2009 N EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2010
Practice Address - Country:US
Practice Address - Phone:903-572-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025813Medicaid