Healthcare Provider Details

I. General information

NPI: 1710675475
Provider Name (Legal Business Name): CIVIL ASSIST PATIENT CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 04/29/2023
Certification Date: 04/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WALNUT ST
VALLEY AL
36854-4240
US

IV. Provider business mailing address

1067 JOHNSON LN
VALLEY AL
36854-5523
US

V. Phone/Fax

Practice location:
  • Phone: 312-684-6020
  • Fax:
Mailing address:
  • Phone: 312-684-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: ANTWAN CARTER
Title or Position: PRESIDENT
Credential:
Phone: 312-684-6020