Provider Demographics
NPI:1891846135
Name:COLLEYVILLE PLACE ASSISTED LIVING
Entity type:Organization
Organization Name:COLLEYVILLE PLACE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-427-2273
Mailing Address - Street 1:5314 BRANSFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3530
Mailing Address - Country:US
Mailing Address - Phone:817-427-2273
Mailing Address - Fax:817-503-1960
Practice Address - Street 1:5314 BRANSFORD RD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3530
Practice Address - Country:US
Practice Address - Phone:817-427-2273
Practice Address - Fax:817-503-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117168310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility