Provider Demographics
NPI:1831478775
Name:METROPOLITAN ASSISTED LIVING
Entity type:Organization
Organization Name:METROPOLITAN ASSISTED LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTARTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENEDICTUS
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKOYI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-276-1632
Mailing Address - Street 1:8122 MEADOW POND DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5714
Mailing Address - Country:US
Mailing Address - Phone:404-276-1632
Mailing Address - Fax:
Practice Address - Street 1:8122 MEADOW POND DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5714
Practice Address - Country:US
Practice Address - Phone:404-276-1632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9963311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home