Provider Demographics
NPI:1093426751
Name:THE LODGE AT GUN BARREL CITY LLC
Entity Type:Organization
Organization Name:THE LODGE AT GUN BARREL CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGAPERUMAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-434-9408
Mailing Address - Street 1:300 COUNTY ROAD 1048
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-5277
Mailing Address - Country:US
Mailing Address - Phone:903-434-9408
Mailing Address - Fax:
Practice Address - Street 1:155 DUNAWAY AVE
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156
Practice Address - Country:US
Practice Address - Phone:903-608-9024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness