Provider Demographics
NPI:1588333223
Name:PROMISE LAND ESTATES, LLC
Entity type:Organization
Organization Name:PROMISE LAND ESTATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AVIS
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-539-4470
Mailing Address - Street 1:1411 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-4134
Mailing Address - Country:US
Mailing Address - Phone:501-539-4770
Mailing Address - Fax:501-436-0908
Practice Address - Street 1:1411 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-4134
Practice Address - Country:US
Practice Address - Phone:501-539-4470
Practice Address - Fax:501-791-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodging
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty