Provider Demographics
NPI:1922420132
Name:CCAL 2013 RE, LLC
Entity Type:Organization
Organization Name:CCAL 2013 RE, LLC
Other - Org Name:CAMBRIDGE COURT ASSISTED LIVING AND MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-386-8888
Mailing Address - Street 1:3801 HULEN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7202
Mailing Address - Country:US
Mailing Address - Phone:817-386-8888
Mailing Address - Fax:817-386-8324
Practice Address - Street 1:711 MATADOR LN
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-8830
Practice Address - Country:US
Practice Address - Phone:972-285-9800
Practice Address - Fax:972-285-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX050648310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility