Provider Demographics
NPI:1215322169
Name:MIDTOWN 2013 RE, LLC
Entity type:Organization
Organization Name:MIDTOWN 2013 RE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:817-386-8888
Mailing Address - Street 1:3801 HULEN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7202
Mailing Address - Country:US
Mailing Address - Phone:817-386-8888
Mailing Address - Fax:
Practice Address - Street 1:910 S. 9TH STREET
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065
Practice Address - Country:US
Practice Address - Phone:469-615-0720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility