Provider Demographics
NPI:1154519148
Name:VALLEY RANCH DELUXE SENIOR LIVING
Entity type:Organization
Organization Name:VALLEY RANCH DELUXE SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-831-8200
Mailing Address - Street 1:8855 VALLEY RANCH PKWY W
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4630
Mailing Address - Country:US
Mailing Address - Phone:972-831-8200
Mailing Address - Fax:972-831-1515
Practice Address - Street 1:8855 VALLEY RANCH PKWY W
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4630
Practice Address - Country:US
Practice Address - Phone:972-831-8200
Practice Address - Fax:972-831-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109596310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility