Provider Demographics
NPI:1396951315
Name:THE ESTATES AT GRAND PRAIRIE INC
Entity type:Organization
Organization Name:THE ESTATES AT GRAND PRAIRIE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:MA,PHD
Authorized Official - Phone:817-437-6657
Mailing Address - Street 1:1005 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3034
Mailing Address - Country:US
Mailing Address - Phone:972-237-1943
Mailing Address - Fax:972-237-5964
Practice Address - Street 1:1005 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3034
Practice Address - Country:US
Practice Address - Phone:972-237-1943
Practice Address - Fax:972-237-5964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118696310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility