1447487731 NPI number — EVERLASTING ASSISTED LIVING LLC

Table of content: MISS CYNTHIA AGATHA VIOLA LEWIS RN REGISTERED NURSE (NPI 1811298847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447487731 NPI number — EVERLASTING ASSISTED LIVING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVERLASTING ASSISTED LIVING 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:
1447487731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 W WILLOUGHBY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88005-1822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-805-3394
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6485 SEXTON LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88012-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-805-3394
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VILLEGAS
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER MANGER
Authorized Official Telephone Number:
575-541-0551

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  03164656005 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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