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GREYSTONE PARK
NPI 1164640363
Assisted Living Facility in Jacksboro, TX

Active since April 23, 2007CLIA 45D2270418 · Waiver
1116 US HIGHWAY 148, JACKSBORO, TX 76458(940) 567-3057(940) 567-5782 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Greystone Park NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREYSTONE PARK (NPI 1164640363) is a healthcare organization registered as an assisted living facility in Jacksboro, Texas and active in the NPI registry since April 2007. The organization holds a CLIA Waiver certificate valid through October 13, 2026 and lists Sam T Jewell, President, as its authorized official.

NPPES Registry Identity

NPI1164640363
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameJACKSBORO ASSISTED LIVING, INC.
Location Address1116 US HIGHWAY 148Jacksboro, TX 76458-3439
Mailing Address1116 Us Highway 148Jacksboro, TX 76458-3439 · (940) 567-3057 · Fax (940) 567-5782
Phone(940) 567-3057
Fax(940) 567-5782
Organization SubpartNo
Authorized OfficialSam T JewellPresident · (580) 622-6300
Enumeration DateApril 23, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1164640363 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in TX · 120111
Definition
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.
1116 US HIGHWAY 148, Jacksboro, TX 76458
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Other Names 1

Doing Business AsGreystone Park

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2270418

Jacksboro Assisted Living · Jacksboro, TX
Active · expires Oct 13, 2026
CLIA Number45D2270418
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 14, 2024
Certificate Expiration DateOctober 13, 2026
Laboratory DirectorBecky Taff
Laboratory Phone(940) 567-3057
Laboratory LocationJacksboro Assisted Living1116 Us Sh 148, Jacksboro, TX 76458
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacksboro Assisted Living, Inc.'s NPI number?

The NPI number for Jacksboro Assisted Living, Inc. is 1164640363. It was assigned to this organization in the NPPES registry on April 23, 2007. The provider is doing business as Greystone Park.

Where is Jacksboro Assisted Living, Inc. located?

Jacksboro Assisted Living, Inc. is located at 1116 Us Highway 148, Jacksboro, TX 76458. The listed phone number is (940) 567-3057.

What is Jacksboro Assisted Living, Inc.'s specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Jacksboro Assisted Living, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2270418) is associated with this NPI, valid through October 13, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jacksboro Assisted Living, Inc. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.