TCG Benbrook Al, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

000619 Issued in TX

Legal business name

TCG BENBROOK AL, LLC

Doing business as

Mirabella Assisted Living

Practice address

4242 Bryant Irvin Rd
Covenant Place of Burleson, LP
Benbrook, TX 76109-4222

Phone

(817) 763-0088

Fax

(817) 763-8841

NPI assigned

Apr 16, 2007

Last updated

Feb 17, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

COVENANT GROUP OF TEXAS, LPAs reported in NPPES

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

Authorized official

Name

Mr. Bryan D. McCaleb

Title

President

Phone

(817) 446-4792

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mirabella Assisted Living Doing business as

Locations

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424131200000",
    "number": "1528283280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SUMMIT AVE",
            "address_2": "SUITE 444",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761024403",
            "telephone_number": "817-446-4792",
            "fax_number": "817-446-0923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4242 BRYANT IRVIN RD",
            "address_2": "COVENANT PLACE OF BURLESON, LP",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761094222",
            "telephone_number": "817-763-0088",
            "fax_number": "817-763-8841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TCG BENBROOK AL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COVENANT GROUP OF TEXAS, LP",
        "enumeration_date": "2007-04-16",
        "last_updated": "2015-02-17",
        "status": "A",
        "authorized_official_last_name": "MCCALEB",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-446-4792",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "000619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CBA VENDOR NUMBER",
            "identifier": "001014575",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mirabella Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Benbrook, TX
• Providers in Benbrook, 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 Feb 17, 2015; 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.