1033768536 NPI number — SCHOOL ROAD SENIOR LIVING, LLC

Table of content: EARL KNOWLES PHARES JR. DDS (NPI 1295956423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033768536 NPI number — SCHOOL ROAD SENIOR LIVING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHOOL ROAD SENIOR 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:
1033768536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2668 NORTHPARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80026-3199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-952-9216
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 PELZER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASLEY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29642-2941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-249-1040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ESTES
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
COUNSEL
Authorized Official Telephone Number:
503-510-5000

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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