Provider Demographics
NPI:1548402696
Name:RUBYE B LEWALLEN
Entity Type:Organization
Organization Name:RUBYE B LEWALLEN
Other - Org Name:LEWALLEN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBYE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEWALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-597-9167
Mailing Address - Street 1:507 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRADY
Mailing Address - State:TX
Mailing Address - Zip Code:76825-5116
Mailing Address - Country:US
Mailing Address - Phone:325-597-9167
Mailing Address - Fax:325-597-4622
Practice Address - Street 1:507 E 6TH ST
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-5116
Practice Address - Country:US
Practice Address - Phone:325-597-9167
Practice Address - Fax:325-597-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility