Provider Demographics
NPI:1215071428
Name:BARTON CREEK SENIOR LIVING CENTER INC.
Entity type:Organization
Organization Name:BARTON CREEK SENIOR LIVING CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DICKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-610-9424
Mailing Address - Street 1:2500 BARTON CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-1616
Mailing Address - Country:US
Mailing Address - Phone:512-610-9424
Mailing Address - Fax:512-610-9427
Practice Address - Street 1:2500 BARTON CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-1616
Practice Address - Country:US
Practice Address - Phone:512-610-9424
Practice Address - Fax:512-610-9427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility