Provider Demographics
NPI:1710040498
Name:WINDSOR HEALTHCARE II CORP
Entity Type:Organization
Organization Name:WINDSOR HEALTHCARE II CORP
Other - Org Name:BRIARCLIFF PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER'S REP
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-837-0818
Mailing Address - Street 1:3403 S VINE AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8539
Mailing Address - Country:US
Mailing Address - Phone:903-581-5714
Mailing Address - Fax:903-561-7405
Practice Address - Street 1:3403 S VINE AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8539
Practice Address - Country:US
Practice Address - Phone:903-581-5714
Practice Address - Fax:903-561-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118742310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility