Provider Demographics
NPI:1588806798
Name:LANE'S ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:LANE'S ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOLECHIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-690-9307
Mailing Address - Street 1:4937 MADYSON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-3847
Mailing Address - Country:US
Mailing Address - Phone:817-690-9307
Mailing Address - Fax:
Practice Address - Street 1:2617 CAROLINA DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1661
Practice Address - Country:US
Practice Address - Phone:817-689-0125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility