East Texas Alf Waterton Inn LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EAST TEXAS ALF WATERTON INN LLC

Practice address

2885 Shiloh Rd
Tyler, TX 75703-2936

Phone

(903) 939-9664

NPI assigned

Mar 19, 2012

Organization subpart

No

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

Authorized official

Name

Carla Power

Title

Cfo

Phone

(903) 792-0838

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peggy J Davidson, CRNP

  • Licensed Practical Nurse
  • Tyler, TX
  • NPI 1679583793
  NPD (past)

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

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332115200000",
    "number": "1497020853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2885 SHILOH RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757032936",
            "telephone_number": "903-939-9664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2885 SHILOH RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757032936",
            "telephone_number": "903-939-9664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS ALF WATERTON INN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-19",
        "last_updated": "2012-03-19",
        "status": "A",
        "authorized_official_last_name": "POWER",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "903-792-0838"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Eason
• East Lake Medical, PLLC
• East Side Pharmacy Inc
• East Side Pharmacy Inc
• East Texas Alf Reunion Inn LLC
• East Texas Anesthesiology Associates, P.a.
• East Texas Azalea Operating Company LLC
• East Texas Center for Independent Living
• East Texas Dental Associates, P.a.
• East Texas Dental Group, LLC

• Assisted Living Facility in Tyler, TX
• Providers in Tyler, 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 Mar 19, 2012; 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.