Provider Demographics
NPI:1962635334
Name:WCG ARBOR PLACE ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:WCG ARBOR PLACE ASSISTED LIVING, LLC
Other - Org Name:ARBOR PLACE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-657-1923
Mailing Address - Street 1:PO BOX 1061
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75653-1061
Mailing Address - Country:US
Mailing Address - Phone:903-657-1923
Mailing Address - Fax:903-657-6764
Practice Address - Street 1:1200 KILGORE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-5132
Practice Address - Country:US
Practice Address - Phone:903-657-1923
Practice Address - Fax:903-657-6764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility