Provider Demographics
NPI:1952909616
Name:ROSLYNS SENIOR LIFESTYLE CENTER LLC
Entity Type:Organization
Organization Name:ROSLYNS SENIOR LIFESTYLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-239-9676
Mailing Address - Street 1:21040 HIGHLAND KNOLLS DR STE 200-437
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1570
Mailing Address - Country:US
Mailing Address - Phone:346-239-9676
Mailing Address - Fax:
Practice Address - Street 1:21040 HIGHLAND KNOLLS DR STE 200-437
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1570
Practice Address - Country:US
Practice Address - Phone:346-239-9676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty