Provider Demographics
NPI:1538384912
Name:EXTENDED FAMILY LIVING/JOSEPH LOGSDON
Entity type:Organization
Organization Name:EXTENDED FAMILY LIVING/JOSEPH LOGSDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOGSDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-742-4036
Mailing Address - Street 1:606 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:TX
Mailing Address - Zip Code:79544-2010
Mailing Address - Country:US
Mailing Address - Phone:940-742-4036
Mailing Address - Fax:940-742-7702
Practice Address - Street 1:606 6TH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:TX
Practice Address - Zip Code:79544-2010
Practice Address - Country:US
Practice Address - Phone:940-742-4036
Practice Address - Fax:940-742-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004931Medicaid