Provider Demographics
NPI:1073837589
Name:ATRIA GRAPEVINE
Entity Type:Organization
Organization Name:ATRIA GRAPEVINE
Other - Org Name:ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:REDMON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:817-416-8907
Mailing Address - Street 1:3975 WILLIAM D TATE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7109
Mailing Address - Country:US
Mailing Address - Phone:817-416-8907
Mailing Address - Fax:817-421-9792
Practice Address - Street 1:3975 WILLIAM D TATE AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7109
Practice Address - Country:US
Practice Address - Phone:817-416-8907
Practice Address - Fax:817-421-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX030384310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility