Provider Demographics
NPI:1245336569
Name:R-WAY LLC
Entity type:Organization
Organization Name:R-WAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-753-0060
Mailing Address - Street 1:1101 JOHNNY ROYBAL
Mailing Address - Street 2:INDUSTRIAL PARK RD SUITE A
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2629
Mailing Address - Country:US
Mailing Address - Phone:505-753-0060
Mailing Address - Fax:505-753-0059
Practice Address - Street 1:1101 JOHNNY ROYBAL
Practice Address - Street 2:INDUSTRIAL PARK RD SUITE A
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2629
Practice Address - Country:US
Practice Address - Phone:505-753-0060
Practice Address - Fax:505-753-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D4209Medicare ID - Type Unspecified