Provider Demographics
NPI:1194169383
Name:A PLACE LIKE HOME
Entity type:Organization
Organization Name:A PLACE LIKE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-504-3710
Mailing Address - Street 1:4217 FOXBOROUGH TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-2904
Mailing Address - Country:US
Mailing Address - Phone:817-516-5363
Mailing Address - Fax:
Practice Address - Street 1:4217 FOXBOROUGH TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-2904
Practice Address - Country:US
Practice Address - Phone:817-516-5363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility