Provider Demographics
NPI:1558940239
Name:A & S COMMUNITY LIVING LLC
Entity Type:Organization
Organization Name:A & S COMMUNITY LIVING LLC
Other - Org Name:A & S COMMUNITY LIVING LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-735-4921
Mailing Address - Street 1:3915 EASTER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-5714
Mailing Address - Country:US
Mailing Address - Phone:214-735-4921
Mailing Address - Fax:
Practice Address - Street 1:3915 EASTER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5714
Practice Address - Country:US
Practice Address - Phone:214-735-4921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1558940239Medicaid