Imperial Adult Care Home LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

IMPERIAL ADULT CARE HOME LLC

Practice address

1355 Ventura Dr
Rockwall, TX 75087-2492

Phone

(214) 444-7406

Fax

(469) 719-3685

NPI assigned

Aug 13, 2020

Organization subpart

No

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

Authorized official

Name

Sakwe Bongo McDonald

Title

Owner

Phone

(214) 444-7406

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1528679461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 VENTURA DR",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750872492",
            "telephone_number": "214-444-7406",
            "fax_number": "469-719-3685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 VENTURA DR",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750872492",
            "telephone_number": "214-444-7406",
            "fax_number": "469-719-3685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL ADULT CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "BONGO MCDONALD",
        "authorized_official_first_name": "SAKWE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-444-7406"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; 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.