Provider Demographics
NPI:1871630459
Name:KENNETH BEASON ALVIS HOUSE
Entity Type:Organization
Organization Name:KENNETH BEASON ALVIS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-742-4159
Mailing Address - Street 1:705 CAROTHERS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:TX
Mailing Address - Zip Code:79544-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:805 CAROTHERS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:TX
Practice Address - Zip Code:79544-2001
Practice Address - Country:US
Practice Address - Phone:970-742-4159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility