1134303043 NPI number — SANTA TERESA PROVIDER ASSISTED SERVICES LLC

Table of content: (NPI 1134303043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134303043 NPI number — SANTA TERESA PROVIDER ASSISTED SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANTA TERESA PROVIDER ASSISTED SERVICES 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:
SANTA TERESA PAS LLC
Provider Other Organization Name Type Code:
3
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:
1134303043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9440 VISCOUNT BLVD STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79925-7054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-217-8307
Provider Business Mailing Address Fax Number:
915-219-8271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9440 VISCOUNT BLVD STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79925-7054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-217-8307
Provider Business Practice Location Address Fax Number:
915-219-8271
Provider Enumeration Date:
12/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAZQUEZ
Authorized Official First Name:
ENGRACIA
Authorized Official Middle Name:
DEL ROCIO
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
915-217-8307

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  623430 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 011110 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 011110 . This is a "TEXAS DEPT OF AGING AND D" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".