Provider Demographics
NPI:1881195386
Name:EC OPCO LAKE JACKSON, LLC
Entity Type:Organization
Organization Name:EC OPCO LAKE JACKSON, LLC
Other - Org Name:ECLIPSE SENIOR LIVING, INC. (MANAGEMENT COMPANY)
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER/MANAGEMENT COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-337-3922
Mailing Address - Street 1:500 N HURSTBOURNE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3301
Mailing Address - Country:US
Mailing Address - Phone:971-213-4234
Mailing Address - Fax:
Practice Address - Street 1:206 OAK DR S
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5782
Practice Address - Country:US
Practice Address - Phone:979-297-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility