Basic Information
| Provider Information | |||||||||
| NPI: | 1588380786 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHR LEAGUE CITY TRS SUB, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18191 VON KARMAN AVE FL 3 | ||||||||
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| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926127102 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 ENTERPRISE AVE | ||||||||
| Address2: | |||||||||
| City: | LEAGUE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775732924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815385993 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2022 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | PROSKY | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9492709214 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.