Provider Demographics
NPI:1013268838
Name:COLD WATER CREEK RESIDENTIAL LLC
Entity Type:Organization
Organization Name:COLD WATER CREEK RESIDENTIAL LLC
Other - Org Name:CARING HEARTS OF ARLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAZVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSELELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-226-4037
Mailing Address - Street 1:1610 MT ZION DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-3090
Mailing Address - Country:US
Mailing Address - Phone:214-226-4037
Mailing Address - Fax:817-763-0315
Practice Address - Street 1:1610 MT ZION DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-3090
Practice Address - Country:US
Practice Address - Phone:214-226-4037
Practice Address - Fax:817-763-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home