1457551749 NPI number — MAHARLIKA RESOURCES, INC.

Table of content: (NPI 1457551749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457551749 NPI number — MAHARLIKA RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAHARLIKA RESOURCES, 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:
6
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:
1457551749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11913 PASEO DORADO CIR
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:
79936-3785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-329-1039
Provider Business Mailing Address Fax Number:
866-838-4666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 JUNCTION HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERRVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78028-9392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-792-4001
Provider Business Practice Location Address Fax Number:
866-838-4666
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
DIONICIO
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
915-329-1039

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  102640 , 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)

  • Identifier: 102640 . This is a "ASSISTED LIVING FACILITY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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