1275942005 NPI number — LIFEWAY COMMUNITY CARE & SITTING SERVICES

Table of content: MR. EVAN GRATTAN HATCH MD (NPI 1447838081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275942005 NPI number — LIFEWAY COMMUNITY CARE & SITTING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEWAY COMMUNITY CARE & SITTING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275942005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 WEST PIONEER PARKWAY SUITE 17
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-591-1706
Provider Business Mailing Address Fax Number:
817-591-1707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 WEST PIONEER PARKWAY SUITE 17
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-591-1706
Provider Business Practice Location Address Fax Number:
817-591-1707
Provider Enumeration Date:
08/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CLINTON
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
817-591-1706

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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