Provider Demographics
NPI:1083879993
Name:MCKINNEY AUTUMN LEAVES, LP
Entity Type:Organization
Organization Name:MCKINNEY AUTUMN LEAVES, LP
Other - Org Name:AUTUMN LEAVES OF MCKINNEY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-239-8400
Mailing Address - Street 1:545 E JOHN CARPENTER FWY
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3931
Mailing Address - Country:US
Mailing Address - Phone:214-239-8400
Mailing Address - Fax:
Practice Address - Street 1:175 PLATEAU DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7413
Practice Address - Country:US
Practice Address - Phone:972-542-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102401310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility