Basic Information
| Provider Information | |||||||||
| NPI: | 1881195386 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EC OPCO LAKE JACKSON, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ECLIPSE SENIOR LIVING, INC. (MANAGEMENT COMPANY) | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 N HURSTBOURNE PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402223301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712134234 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 206 OAK DR S | ||||||||
| Address2: | |||||||||
| City: | LAKE JACKSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775665782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9792975577 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2018 | ||||||||
| LastUpdateDate: | 05/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | FLEMING | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER/MANAGEMENT COMPANY | ||||||||
| AuthorizedOfficialTelephone: | 9713373922 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.