Civitas Dra 2016 Managment LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

140585 Issued in TX

Legal business name

CIVITAS DRA 2016 MANAGMENT LLC

Doing business as

Dancing River

Practice address

3735 Ira E Woods Ave
Grapevine, TX 76051-4213

Phone

(817) 442-0505

Fax

(817) 386-8324

NPI assigned

Sep 27, 2016

Last updated

Sep 27, 2016By 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

Lawrence Wayne Powell Jr.

Title

President

Phone

(817) 386-8888

Specialties & licenses 1

Addresses

Other names 1

• Dancing River Doing business as

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

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1487103826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3735 IRA E WOODS AVE",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760514213",
            "telephone_number": "817-442-0505",
            "fax_number": "817-386-8324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3735 IRA E WOODS AVE",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760514213",
            "telephone_number": "817-442-0505",
            "fax_number": "817-386-8324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVITAS DRA 2016 MANAGMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-27",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-386-8888",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "140585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dancing River",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christy Porterfield PA (Grapevine Chiropractic)
• Lawton K Chu, DMD
• Wei Lu Chuang
• Michelle Chung, BCBA
• City of Grapevine (Grapevine Fire Department)
• CKW Group, Advanced Venous Therapy
• Robert Michael Clague, PAC
• Allyssa Destiny Clancy, M.S, CCC-SLP
• Amanda Anne Clark, PA-C
• Edward Deallen Clark, M.D.

• Assisted Living Facility in Grapevine, TX
• Providers in Grapevine, 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 Sep 27, 2016; 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.