GREYSTONE PARK
NPI 1164640363
Assisted Living Facility in Jacksboro, TX
- Organization
- Assisted Living Facility
- CLIA Number: 45D2270418
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 10-13-2026
About GREYSTONE PARK
This page provides the complete NPI Profile along with additional information for Greystone Park, a provider established in Jacksboro, Texas operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1164640363 assigned on April 2007. The practitioner's primary taxonomy code is 310400000X with license number 120111 (TX). The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as Greystone Park. The authorized official of this NPI record is Mr. Sam T Jewell (President)
- NPI
- 1164640363 Verify this NPI
- Provider Legal Name
- JACKSBORO ASSISTED LIVING, INC.
- Other Organization Name
- GREYSTONE PARK
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1116 US HIGHWAY 148 JACKSBORO, TX 76458
- Location Phone
- (940) 567-3057
- Location Fax
- (940) 567-5782
- Mailing Address
- 1116 US HIGHWAY 148 JACKSBORO, TX 76458
- Mailing Phone
- (940) 567-3057
- Mailing Fax
- (940) 567-5782
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-23-2007
- Last Update Date
- 08-22-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 120111
- License State
- TX
- Taxonomy Description
- 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.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 45D2270418
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- October 14, 2024
- Certificate Expiration Date
- October 13, 2026
- Laboratory Director
- BECKY TAFF
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Greystone Park to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164640363, enumerated as an "organization" on April 23, 2007.
The provider is located at 1116 US HIGHWAY 148 JACKSBORO, TX 76458 and the phone number is (940) 567-3057.
Assisted Living Facility with taxonomy code 310400000X.
