Provider Demographics
NPI:1285116137
Name:SAVE OUR SHIP MAROOMS LLC
Entity type:Organization
Organization Name:SAVE OUR SHIP MAROOMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BACHELOR SCIENCE NURSINH
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAWRENCE (AGAPE)
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:478-588-7617
Mailing Address - Street 1:3595 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77703-3517
Mailing Address - Country:US
Mailing Address - Phone:409-833-6002
Mailing Address - Fax:
Practice Address - Street 1:3595 GRAND ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77703-3517
Practice Address - Country:US
Practice Address - Phone:409-444-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty