Provider Demographics
NPI:1235901554
Name:ERASTOP LLC
Entity Type:Organization
Organization Name:ERASTOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TEMITOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKINDE-WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-480-2126
Mailing Address - Street 1:814 N 111TH DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-7941
Mailing Address - Country:US
Mailing Address - Phone:903-480-2126
Mailing Address - Fax:
Practice Address - Street 1:814 N 111TH DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-7941
Practice Address - Country:US
Practice Address - Phone:903-480-2126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERASTOP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances