Provider Demographics
NPI:1215435441
Name:HAMPTON SENIOR LIVING LLC
Entity type:Organization
Organization Name:HAMPTON SENIOR LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNDERBURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-394-8146
Mailing Address - Street 1:1905 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-8001
Mailing Address - Country:US
Mailing Address - Phone:512-394-8146
Mailing Address - Fax:512-672-6200
Practice Address - Street 1:1905 HAMPTON LN
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-8001
Practice Address - Country:US
Practice Address - Phone:512-394-8146
Practice Address - Fax:512-672-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144387310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility