Provider Demographics
NPI:1194124503
Name:KNOPP ASSISTED LIVING CENTER, INC
Entity type:Organization
Organization Name:KNOPP ASSISTED LIVING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORNJEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-997-3704
Mailing Address - Street 1:202 BILLIE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5056
Mailing Address - Country:US
Mailing Address - Phone:830-997-7924
Mailing Address - Fax:888-550-4105
Practice Address - Street 1:202 BILLIE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5056
Practice Address - Country:US
Practice Address - Phone:830-997-7924
Practice Address - Fax:888-550-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136912310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136912OtherDADS