Provider Demographics
NPI:1679246235
Name:UPPER ROOM COOPERATE HOUSING, INC
Entity Type:Organization
Organization Name:UPPER ROOM COOPERATE HOUSING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-903-7600
Mailing Address - Street 1:9613 LOG RUN CT
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-4962
Mailing Address - Country:US
Mailing Address - Phone:214-778-1107
Mailing Address - Fax:214-778-1454
Practice Address - Street 1:9613 LOG RUN CT
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-4962
Practice Address - Country:US
Practice Address - Phone:214-778-1107
Practice Address - Fax:214-778-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home