Provider Demographics
NPI:1013334721
Name:CASABLANCA ASSISTED LIVING AND MEMORY CARE
Entity Type:Organization
Organization Name:CASABLANCA ASSISTED LIVING AND MEMORY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSANES
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:972-816-9663
Mailing Address - Street 1:6617 DAN DANCIGER RD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-4905
Mailing Address - Country:US
Mailing Address - Phone:817-292-0925
Mailing Address - Fax:
Practice Address - Street 1:6617 DAN DANCIGER RD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-4905
Practice Address - Country:US
Practice Address - Phone:817-292-0925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000671251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management