Provider Demographics
NPI:1063652535
Name:EJS CONSTRUCTION AND DEVELOPMENT, L.L.C.
Entity Type:Organization
Organization Name:EJS CONSTRUCTION AND DEVELOPMENT, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENTREPRENEUR
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANTISTEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-249-1940
Mailing Address - Street 1:2120 MANCHESTER PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3091
Mailing Address - Country:US
Mailing Address - Phone:505-249-1940
Mailing Address - Fax:505-344-8121
Practice Address - Street 1:2120 MANCHESTER PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3091
Practice Address - Country:US
Practice Address - Phone:505-249-1940
Practice Address - Fax:505-344-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM352675171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM352675OtherGENERAL CONTRACTORS LICENSE
NM70282536Medicaid