Provider Type Icon

JACKSBORO ASSISTED LIVING INC. NPI 1164640363


NPI Information

NPI: 1164640363
Provider Name: JACKSBORO ASSISTED LIVING, INC.

Doing Business As: GREYSTONE PARK

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 45D2270418

Address:
1116 US HIGHWAY 148
JACKSBORO, TX
ZIP 76458
Phone: (940) 567-3057
Get Directions

JACKSBORO ASSISTED LIVING, INC. is an assisted living facility in Jacksboro, TX. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. JACKSBORO ASSISTED LIVING, INC. NPI is 1164640363. The provider is registered as an organization entity type.
The provider Is Doing Business As Greystone Park.

The provider's business location address is:

1116 US HIGHWAY 148
JACKSBORO, TX
ZIP 76458-439
Phone: (940) 567-3057
Fax: (940) 567-5782

The provider's authorized official is Sam T Jewell .
The authorized official title is President and has the following contact phone number (580) 622-6300.

The CLIA number assigned to this NPI record is 45D2270418 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/23/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living Facility120111TEXASYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.