Provider Demographics
NPI:1922585769
Name:ENLIVEN SPECIALTY NURSING OF TEXAS, LLC
Entity Type:Organization
Organization Name:ENLIVEN SPECIALTY NURSING OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-549-0714
Mailing Address - Street 1:14122 W MCDOWELL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2503
Mailing Address - Country:US
Mailing Address - Phone:623-478-2797
Mailing Address - Fax:
Practice Address - Street 1:700 N ESTRELLA PKWY STE 235
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9332
Practice Address - Country:US
Practice Address - Phone:623-478-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENLIVEN HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-24
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care