1891040127 NPI number — CATERED LIVING SA, LLC

Table of content: (NPI 1891040127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891040127 NPI number — CATERED LIVING SA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATERED LIVING SA, 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:
NATIONAL INDEPENDENT SENIORCARE
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:
1891040127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1635 NE LOOP 410
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78209-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-822-2654
Provider Business Mailing Address Fax Number:
210-822-2982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18323 SONTERRA PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-4353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-291-7770
Provider Business Practice Location Address Fax Number:
210-822-2982
Provider Enumeration Date:
07/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
IBARRA
Authorized Official First Name:
JEANETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
210-822-2654

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  015525 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 015525 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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