Provider Demographics
NPI:1972889533
Name:AURORA RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:AURORA RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-225-8208
Mailing Address - Street 1:3813 BRANDYWINE DR
Mailing Address - Street 2:313
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5253
Mailing Address - Country:US
Mailing Address - Phone:817-225-8208
Mailing Address - Fax:817-685-6669
Practice Address - Street 1:3813 BRANDYWINE DR
Practice Address - Street 2:313
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5253
Practice Address - Country:US
Practice Address - Phone:817-225-8208
Practice Address - Fax:817-685-6669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities