Provider Demographics
NPI:1497250005
Name:ENTRUST SENIOR LIVING OF DESOTO LLC
Entity Type:Organization
Organization Name:ENTRUST SENIOR LIVING OF DESOTO LLC
Other - Org Name:ENTRUST SENIOR LIVING OF DESOTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-242-8300
Mailing Address - Street 1:2334 WASHINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2159
Mailing Address - Country:US
Mailing Address - Phone:530-242-8300
Mailing Address - Fax:
Practice Address - Street 1:8027 W VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3767
Practice Address - Country:US
Practice Address - Phone:972-298-1331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility