Provider Demographics
NPI:1356022065
Name:SACRED HEARTS ASSISTED LIVING LLC
Entity type:Organization
Organization Name:SACRED HEARTS ASSISTED LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR/COO
Authorized Official - Prefix:MS
Authorized Official - First Name:LEDALE
Authorized Official - Middle Name:LASHETTE
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-410-3250
Mailing Address - Street 1:830 NORTH BLVD UNIT 2273
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-2311
Mailing Address - Country:US
Mailing Address - Phone:210-331-4341
Mailing Address - Fax:
Practice Address - Street 1:10772 ROSALINA LOOP
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-4450
Practice Address - Country:US
Practice Address - Phone:210-410-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health