Provider Demographics
NPI:1699012518
Name:MAJESTIC SENIOR LIVING HASKELL LLC
Entity Type:Organization
Organization Name:MAJESTIC SENIOR LIVING HASKELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-222-0417
Mailing Address - Street 1:2323 TOWNEHEIGHTS TER SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7408
Mailing Address - Country:US
Mailing Address - Phone:352-222-0417
Mailing Address - Fax:352-433-4077
Practice Address - Street 1:1302 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521-5434
Practice Address - Country:US
Practice Address - Phone:940-864-2727
Practice Address - Fax:940-864-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility