Provider Demographics
NPI:1154199891
Name:PURIST LIVING LLC
Entity type:Organization
Organization Name:PURIST LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULITO
Authorized Official - Middle Name:
Authorized Official - Last Name:UY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-341-0153
Mailing Address - Street 1:201 WESTGATE PKWY W A2
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1110
Mailing Address - Country:US
Mailing Address - Phone:806-341-0153
Mailing Address - Fax:
Practice Address - Street 1:201 WESTGATE PKWY W A2
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1110
Practice Address - Country:US
Practice Address - Phone:806-341-0153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care