1417015322 NPI number — INDEPENDENT LIVING OF TEXARKANA, LLC

Table of content: STEVEN FINAS SMITH LMAC (NPI 1588153605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417015322 NPI number — INDEPENDENT LIVING OF TEXARKANA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENT LIVING OF TEXARKANA, LLC
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:
1417015322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3120 SMITH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75501-4083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-831-3911
Provider Business Mailing Address Fax Number:
903-831-4195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3120 SMITH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75501-4083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-831-3911
Provider Business Practice Location Address Fax Number:
903-831-4195
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PINTER
Authorized Official First Name:
FAGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
903-831-3911

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  118529 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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