Healthcare Provider Details

I. General information

NPI: 1154199891
Provider Name (Legal Business Name): PURIST LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WESTGATE PKWY W A2
AMARILLO TX
79121-1110
US

IV. Provider business mailing address

201 WESTGATE PKWY W A2
AMARILLO TX
79121-1110
US

V. Phone/Fax

Practice location:
  • Phone: 806-341-0153
  • Fax:
Mailing address:
  • Phone: 806-341-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULITO UY
Title or Position: OWNER
Credential: MD
Phone: 806-341-0153