Provider Demographics
NPI:1518010222
Name:ASSURANCE HOME INC.
Entity Type:Organization
Organization Name:ASSURANCE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-624-1780
Mailing Address - Street 1:1000 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-7532
Mailing Address - Country:US
Mailing Address - Phone:505-624-1780
Mailing Address - Fax:505-624-2033
Practice Address - Street 1:1000 E 18TH ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-7532
Practice Address - Country:US
Practice Address - Phone:505-624-1780
Practice Address - Fax:505-624-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4079322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children