Provider Demographics
NPI:1407320385
Name:THREE RIVERS ADVISORS, LLC
Entity Type:Organization
Organization Name:THREE RIVERS ADVISORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:704-470-7640
Mailing Address - Street 1:11300 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-2652
Mailing Address - Country:US
Mailing Address - Phone:512-962-9919
Mailing Address - Fax:512-518-3656
Practice Address - Street 1:11300 HUNTERS LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-2652
Practice Address - Country:US
Practice Address - Phone:512-900-3306
Practice Address - Fax:512-518-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106824OtherSTATE LICENSURE