NPIMap

Organization Active NPI

Clear Lake Memory Care, LLC

Doing business as Autumn Leaves of Clear Lake

  • Assisted Living Facility
  • Irving, TX
National Provider Identifier
1881954592
Registry record updated May 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
105048 Issued in TX
Legal business name
CLEAR LAKE MEMORY CARE, LLC
Doing business as
Autumn Leaves of Clear Lake
Practice address
545 E John Carpenter Fwy
Suite 500
Irving, TX 75062-3931
Phone
(214) 845-4500
Fax
(214) 845-4501
NPI assigned
May 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2012

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

Authorized official

Name
Mr. Chad Anderson
Title
President
Phone
(214) 845-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 105048 TX Primary

Addresses

Primary practice location

545 E John Carpenter Fwy
Suite 500
Irving, TX 75062-3931

Mailing address

545 E John Carpenter Fwy
Suite 500
Irving, TX 75062-3931
Phone (214) 845-4500

Other names 1

  • Autumn Leaves of Clear Lake Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Autumn Leaves of Clear Lake2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1338249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338249600000",
    "number": "1881954592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 E JOHN CARPENTER FWY",
            "address_2": "SUITE 500",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750623931",
            "telephone_number": "214-845-4500",
            "fax_number": "214-845-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 E JOHN CARPENTER FWY",
            "address_2": "SUITE 500",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750623931",
            "telephone_number": "214-845-4500",
            "fax_number": "214-845-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR LAKE MEMORY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-29",
        "last_updated": "2012-05-29",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-845-4500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "105048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Leaves of Clear Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irving, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.