Provider Demographics
NPI:1609011303
Name:MANOR ASSISTED CARE LLC
Entity Type:Organization
Organization Name:MANOR ASSISTED CARE LLC
Other - Org Name:MANOR CARE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-224-4015
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-0425
Mailing Address - Country:US
Mailing Address - Phone:972-224-4015
Mailing Address - Fax:972-224-4339
Practice Address - Street 1:104 CHOWNING DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4900
Practice Address - Country:US
Practice Address - Phone:972-224-4015
Practice Address - Fax:972-224-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000229341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201118101Medicaid
TX201118101Medicaid