Provider Demographics
NPI:1407380108
Name:2410 STILLHOUSE SENIOR LIVING, INC.
Entity Type:Organization
Organization Name:2410 STILLHOUSE SENIOR LIVING, INC.
Other - Org Name:PARIS CHALET SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:2410 STILLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-2065
Mailing Address - Country:US
Mailing Address - Phone:903-784-8800
Mailing Address - Fax:903-737-2964
Practice Address - Street 1:2410 STILLHOUSE RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-2065
Practice Address - Country:US
Practice Address - Phone:903-784-8800
Practice Address - Fax:903-737-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility