Provider Demographics
NPI:1598314619
Name:ELDORADO WEST SENIOR LIVING
Entity Type:Organization
Organization Name:ELDORADO WEST SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAN YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-718-1120
Mailing Address - Street 1:6628 MYRTLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6302
Mailing Address - Country:US
Mailing Address - Phone:214-718-1120
Mailing Address - Fax:972-307-5385
Practice Address - Street 1:3051 W ELDORADO PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-3537
Practice Address - Country:US
Practice Address - Phone:469-777-3151
Practice Address - Fax:972-307-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances