Fossil Creek Memory Care LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

103208 Issued in TX

Legal business name

FOSSIL CREEK MEMORY CARE LLC

Practice address

4501 Silver Sage Dr
Haltom City, TX 76137-5825

Phone

(817) 849-8000

NPI assigned

Jul 21, 2008

Organization subpart

No

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

Authorized official

Name

Chad Anderson

Title

President

Phone

(214) 239-8400

Specialties & licenses 1

Addresses

Other names 1

• Autumn Leaves of Fossil Creek Other name

Locations

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

{
    "created_epoch": "1216598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216598400000",
    "number": "1891950762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 E JOHN CARPENTER FWY",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750623931",
            "telephone_number": "214-239-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 SILVER SAGE DR",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "761375825",
            "telephone_number": "817-849-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOSSIL CREEK MEMORY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-21",
        "last_updated": "2008-07-21",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-239-8400"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "103208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Leaves of Fossil Creek",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Assisted Living Facility in Haltom City, TX
• Providers in Haltom City, 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 Jul 21, 2008; 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.