Jacksboro Assisted Living, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

120111 Issued in TX

Legal business name

JACKSBORO ASSISTED LIVING, INC.

Doing business as

Greystone Park

Practice address

1116 US Highway 148
Jacksboro, TX 76458-3439

Phone

(940) 567-3057

Fax

(940) 567-5782

NPI assigned

Apr 23, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Sam T Jewell

Title

President

Phone

(580) 622-6300

Specialties & licenses 1

Addresses

Other names 1

• GREYSTONE PARK Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Barton House Nashville2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Davidson County Assisted Living LLC

  dba Barton House Nashville

  • Assisted Living Facility (Mental Illness)
  • Nashville, TN
  • NPI 1770760829
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164640363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 US HIGHWAY 148",
            "city": "JACKSBORO",
            "state": "TX",
            "postal_code": "764583439",
            "telephone_number": "940-567-3057",
            "fax_number": "940-567-5782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 US HIGHWAY 148",
            "city": "JACKSBORO",
            "state": "TX",
            "postal_code": "764583439",
            "telephone_number": "940-567-3057",
            "fax_number": "940-567-5782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSBORO ASSISTED LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JEWELL",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "580-622-6300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "120111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREYSTONE PARK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jack County Hospital District (faith community hospital amb surg)
• Jack County Hospital District (Faith Community Hospital Ambulance)
• Jack County Hospital District (Avir at Jacksboro)
• Jack County Hospital District (Faith Community Hospital)
• Jack County Hospital District (Faith Community Hospital)
• Jacksboro Health Care Center
• Jacksboro Independent School District
• Syed M Jamal, MD
• Lara M. Pierce, MD PLLC (Jacksboro Clinic)
• John Edward Lockyer

• Assisted Living Facility in Jacksboro, TX
• Providers in Jacksboro, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.