1225114598 NPI number — LIFEWORKS UNLIMITED INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225114598 NPI number — LIFEWORKS UNLIMITED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEWORKS UNLIMITED INC
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:
1225114598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13914
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:
88013-3914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-523-4036
Provider Business Mailing Address Fax Number:
575-523-4038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3831 E LOHMAN AVE # 2
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:
88011-8266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-523-4036
Provider Business Practice Location Address Fax Number:
575-523-4038
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASTELLANOS
Authorized Official First Name:
LUISA
Authorized Official Middle Name:
PASTORA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
575-523-4036

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1297 , 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)

  • Identifier: 86998 . This is a "PRESBYTERIAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM102144 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 00NM00JM73 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 53784740 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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