Red Beard LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

RED BEARD LLC

Doing business as

Country Manor Assisted Living

Practice address

265 County Road 613
Dayton, TX 77535

Phone

(936) 258-6803

NPI assigned

Jun 8, 2017

Organization subpart

No

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

Authorized official

Name

Rebecca Johnson

Title

Owner/Manager

Phone

(936) 776-0703

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Manor Assisted Living Doing business as

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1235668625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 COUNTY ROAD 613",
            "city": "DAYTON",
            "state": "TX",
            "postal_code": "775354325",
            "telephone_number": "936-258-6803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 COUNTY ROAD 613",
            "city": "DAYTON",
            "state": "TX",
            "postal_code": "77535",
            "telephone_number": "936-258-6803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED BEARD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "936-776-0703"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS DEPARTMENT OF AGING",
            "identifier": "310400000X",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Manor Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Country Manor Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Dayton, TX
• Providers in Dayton, 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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.