MG AL GRAND PRAIRIE LLC (NPI# 1790309482) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790309482 |
| Entity Type | Organization |
| Organization Name | MG AL GRAND PRAIRIE LLC |
| Other Organization Name | MAYBERRY GARDENS |
| Practice Address |
540 E Polo Rd Bldg 3 Grand Prairie TX 75052-3503 |
| Mailing Address |
3272 N Garland Ave Garland TX 75040-3207 |
| Practice Telephone | 9729759044 |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2020-06-10 |
| Authorized Official Name | ADRIAN HEWITT (OWNER) |
| Authorized Official Telephone | 9722138135 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Mayberry Gardens | Doing Business As Name - Organization |
| Street Address |
540 E POLO RD BLDG 3 |
| City | GRAND PRAIRIE |
| State | TX |
| Zip Code | 75052-3503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487265542 | Beyond Home Health Care LLC | Registered Nurse | 3531 Pecos Way, Grand Prairie, TX 75052 | 2020-08-12 |
| 1497370332 | Michael Cooper | Dentist | 3154 South Hwy 161 Ste 640, Grand Prairie, TX 75052 | 2020-06-16 |
| 1043835788 | Amanda Azubike | Licensed Practical Nurse | 4593 Mt Laurel Dr, Grand Prairie, TX 75052 | 2020-06-09 |
| 1457992844 | Epic West Family Dnetistry Pllc | Dentist | 3166 Sh 161, Ste 190, Grand Prairie, TX 75052 | 2019-10-07 |
| 1033777487 | National Vision Inc | Optometrist | 3166 South Highway 161, Suite 160, Grand Prairie, TX 75052 | 2019-05-31 |
| 1689136624 | Raushanah Taherrah Shareef-jefferson | Dental Hygienist | 831 Ridgecrest Rd, Grand Prairie, TX 75052 | 2019-04-01 |
| 1053812552 | Dfw Better Care Physicians, Pllc | Clinic/Center | 5204 Tx 360 #400, Grand Prairie, TX 75052 | 2018-02-21 |
| 1629586797 | Grand Prairie Marvel Dental Pllc | Clinic/Center | 5020 S Hwy 360, Suite 200, Grand Prairie, TX 75052 | 2018-01-11 |
| 1033626221 | Thad Taylor Iv Dds | Dentist | 3261 S. Carrier Pkwy., Grand Prairie, TX 75052 | 2018-01-09 |
| 1902312796 | Real Dental Pllc | Dentist | 1215 W. Pioneer Pkwy, Suite 130, Grand Prairie, TX 75052 | 2017-12-16 |
| Find all providers in zip 75052 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760004394 | Gilgal Assisted Living | Assisted Living Facility | 2968 Volturno Dr, Grand Prairie, TX 75052-8731 | 2020-05-18 |
| 1285115048 | Chyma Care Services | Assisted Living Facility | 5107 Clydesdale Dr, Grand Prairie, TX 75052-2565 | 2018-08-28 |
| 1811478068 | Tanishcia Moore | Assisted Living Facility | 2935 Paladium Dr, Grand Prairie, TX 75052-8045 | 2018-08-26 |
| 1003327495 | Peace of Mind Home Care | Assisted Living Facility | 410 Nw 11th St, Grand Prairie, TX 75050-5416 | 2017-10-12 |
| 1215447636 | Hands of Healing Provider Services, PC | Assisted Living Facility | 2903 Lavanda, Grand Prairie, TX 75054-5559 | 2017-10-11 |
| 1659703627 | Renon Assisted Living LLC | Assisted Living Facility | 119 Matamoros St, Grand Prairie, TX 75051-4473 | 2013-08-01 |
| 1205063260 | Csh Grand Prairie Lp | Assisted Living Facility | 355 W Westchester Pkwy, Grand Prairie, TX 75052-5284 | 2009-06-17 |
| 1952566168 | Jacqueline A Elzy | Assisted Living Facility | 1375 Saltillo St, Grand Prairie, TX 75051-4460 | 2008-07-28 |
| 1255512695 | A House of Hope | Assisted Living Facility | 2010 Burrows Tr, Grand Prairie, TX 75052 | 2007-11-14 |
| 1750577342 | Community Assisted Living of Grand Prairie, Inc. | Assisted Living Facility | 402 Duncan Perry Rd, Grand Prairie, TX 75050-2907 | 2007-09-18 |
| Find all providers in GRAND PRAIRIE | ||||
| City | GRAND PRAIRIE |
| Zip Code | 75052 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.