Organization · NPI-2

21st Century Living Centers

Intermediate Care Facility, Intellectual Disabilities · Southlake, TX

NPI number1760673164
StatusActive
Last updated in NPPESAug 9, 2007

Details

NPI
1760673164
Entity type
Organization (NPI-2)
Legal business name
21st Century Living Centers
Organization subpart
No
Enumeration date
Aug 9, 2007
Last updated
Aug 9, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
315P00000X Intermediate Care Facility, Intellectual Disabilities000762301TXYes

Other names

  • Brookwood III (Doing Business As)

Practice location

2410 Taylor St
Southlake, TX 76092-3316

Phone 817-424-3338

Mailing address

2695 Lonesome Dove Rd
Southlake, TX 76092-3223

Phone 817-481-5368 · Fax 817-251-0318

Authorized official

Michelle Deanne Neal
Admin/Assistant Qmrp
8174815368

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