Healthcare Provider Details

I. General information

NPI: 1093250284
Provider Name (Legal Business Name): 4C INTERNATIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PRIVATE ROAD 1182
ALVORD TX
76225-7607
US

IV. Provider business mailing address

3905 MELCER DR STE 601
ROWLETT TX
75088-4033
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number856822
License Number StateTX

VIII. Authorized Official

Name: JENNY S CONNALLY
Title or Position: OWNER
Credential: RNFA
Phone: 214-227-2457