Provider Demographics
NPI:1750577342
Name:COMMUNITY ASSISTED LIVING OF GRAND PRAIRIE, INC.
Entity type:Organization
Organization Name:COMMUNITY ASSISTED LIVING OF GRAND PRAIRIE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-633-8511
Mailing Address - Street 1:PO BOX 535369
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053-5369
Mailing Address - Country:US
Mailing Address - Phone:972-206-0402
Mailing Address - Fax:972-206-0408
Practice Address - Street 1:402 DUNCAN PERRY RD
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2907
Practice Address - Country:US
Practice Address - Phone:972-206-0402
Practice Address - Fax:972-206-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119249310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility