Provider Demographics
NPI:1720416209
Name:MERRIWEATHER LIFE LINE
Entity Type:Organization
Organization Name:MERRIWEATHER LIFE LINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON-CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS OF SOCIOLOGY
Authorized Official - Phone:214-664-0867
Mailing Address - Street 1:PO BOX 1191
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-1191
Mailing Address - Country:US
Mailing Address - Phone:214-664-0867
Mailing Address - Fax:972-982-2239
Practice Address - Street 1:RT BOX 1191
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-1191
Practice Address - Country:US
Practice Address - Phone:214-664-0867
Practice Address - Fax:972-982-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization