Provider Demographics
NPI:1538451711
Name:MAC'S ASSISTED LIVING
Entity type:Organization
Organization Name:MAC'S ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVETTA
Authorized Official - Middle Name:EVYONNE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-467-4789
Mailing Address - Street 1:600 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:KERENS
Mailing Address - State:TX
Mailing Address - Zip Code:75144-2725
Mailing Address - Country:US
Mailing Address - Phone:903-467-4789
Mailing Address - Fax:903-396-7518
Practice Address - Street 1:600 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:KERENS
Practice Address - State:TX
Practice Address - Zip Code:75144-2725
Practice Address - Country:US
Practice Address - Phone:903-467-4789
Practice Address - Fax:903-396-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104659310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility