Provider Demographics
NPI:1720574825
Name:CSL AZLE 2016, LLC
Entity Type:Organization
Organization Name:CSL AZLE 2016, LLC
Other - Org Name:LEGACY OAKS OF AZLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:
Authorized Official - Last Name:STIERWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-851-5805
Mailing Address - Street 1:777 MAIN ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5304
Mailing Address - Country:US
Mailing Address - Phone:817-851-5805
Mailing Address - Fax:
Practice Address - Street 1:1364 SOUTHEAST PKWY
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3920
Practice Address - Country:US
Practice Address - Phone:817-629-5136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility