1003142944 NPI number — ESC IV, LP

Table of content: (NPI 1003142944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003142944 NPI number — ESC IV, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESC IV, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BROOKDALE OAK HOLLOW
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003142944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6737 W WASHINGTON ST STE 2300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53214-5650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-918-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2016 L DON DODSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76021-5788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-267-6200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LESKOWICZ
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
414-918-5000

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  010265 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 311500000X , with the licence number: 010265 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)