Provider Demographics
NPI:1538757059
Name:A & S COMMUNITY LIVING LLC
Entity type:Organization
Organization Name:A & S COMMUNITY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-735-4921
Mailing Address - Street 1:6310 S STATE HIGHWAY 360 APT 1326
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8421
Mailing Address - Country:US
Mailing Address - Phone:214-735-4921
Mailing Address - Fax:
Practice Address - Street 1:6310 S STATE HIGHWAY 360 APT 1326
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8421
Practice Address - Country:US
Practice Address - Phone:214-735-4921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility