Provider Demographics
NPI:1326267279
Name:ESC IV, LP
Entity Type:Organization
Organization Name:ESC IV, LP
Other - Org Name:BROOKDALE SIKES LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LESKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:111 WESTWOOD PL STE 400
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5057
Mailing Address - Country:US
Mailing Address - Phone:615-221-2250
Mailing Address - Fax:615-221-2280
Practice Address - Street 1:2649 PLAZA PARKWAY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308
Practice Address - Country:US
Practice Address - Phone:940-696-1351
Practice Address - Fax:940-696-1785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-25
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
TXALZ000385310400000X
TX119444310400000X
TX101276311500000X
TX138910310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF500300750Medicaid