Provider Demographics
NPI:1609136944
Name:JAMES E. RYAN
Entity Type:Organization
Organization Name:JAMES E. RYAN
Other - Org Name:AGNES DENT HOMES III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ERICH
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-797-9859
Mailing Address - Street 1:5280 MARSHA SHARP FWY
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3524
Mailing Address - Country:US
Mailing Address - Phone:806-797-9859
Mailing Address - Fax:806-785-3289
Practice Address - Street 1:5322 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2117
Practice Address - Country:US
Practice Address - Phone:806-797-9859
Practice Address - Fax:806-785-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness