Provider Demographics
NPI:1215630561
Name:ECHELON SENIOR LIVING LLC
Entity type:Organization
Organization Name:ECHELON SENIOR LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:UFONDU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-588-4306
Mailing Address - Street 1:134 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5713
Mailing Address - Country:US
Mailing Address - Phone:972-588-4306
Mailing Address - Fax:972-588-4306
Practice Address - Street 1:140 N MITCHELL RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5407
Practice Address - Country:US
Practice Address - Phone:972-588-4306
Practice Address - Fax:972-588-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility