MG Al Grand Prairie LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MG AL GRAND PRAIRIE LLC

Practice address

540 E Polo Rd BLDG 3
Grand Prairie, TX 75052-3503

Phone

(972) 975-9044

NPI assigned

May 29, 2020

Organization subpart

No

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

Authorized official

Name

Adrian Hewitt

Title

Owner

Phone

(972) 213-8135

Specialties & licenses 1

Addresses

Other names 1

• Mayberry Gardens Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1590710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591747200000",
    "number": "1790309482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3272 N GARLAND AVE",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750403207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 E POLO RD BLDG 3",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523503",
            "telephone_number": "972-975-9044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MG AL GRAND PRAIRIE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-29",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A",
        "authorized_official_last_name": "HEWITT",
        "authorized_official_first_name": "ADRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-213-8135"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adrian@mayberrygardens.com",
            "affiliation": "N",
            "address_1": "540 E Polo Rd",
            "city": "Grand Prairie",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750523503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mayberry Gardens",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Providers in Grand Prairie, 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 Jun 10, 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.