Provider Demographics
NPI:1942890652
Name:AT EASE VETERAN COMMUNITY RESOURCE
Entity Type:Organization
Organization Name:AT EASE VETERAN COMMUNITY RESOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-807-6333
Mailing Address - Street 1:819 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-5316
Mailing Address - Country:US
Mailing Address - Phone:817-807-6333
Mailing Address - Fax:
Practice Address - Street 1:819 BEECH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5316
Practice Address - Country:US
Practice Address - Phone:817-807-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility