Provider Demographics
NPI:1235681594
Name:MASON'S PERSONAL CARE HOMES #2
Entity Type:Organization
Organization Name:MASON'S PERSONAL CARE HOMES #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-235-3076
Mailing Address - Street 1:10451 SUMMER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-7681
Mailing Address - Country:US
Mailing Address - Phone:214-235-3076
Mailing Address - Fax:
Practice Address - Street 1:10451 SUMMER OAKS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-7681
Practice Address - Country:US
Practice Address - Phone:214-235-3076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASON'S PERSONAL CARE HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119220310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility