OrganizationActive
21st Century Living Centers
NPI 1760673164 · Intellectual Disabilities Intermediate Care Facility · Southlake, TX
Provider details
- NPI number
- 1760673164
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Authorized official
- Michelle Neal, Admin/Assistant Qmrp
- License
- 000762301 (TX)
Mailing address
2695 Lonesome Dove Rd
Southlake, TX 76092-3223
Registry dates
- Enumerated
- 2007-08-09
- Last updated
- 2007-08-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.