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General NPI Number Information
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NPI Number | 1164859583
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Entity Type | Organization
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Legal Business Name | MUSTARD SEED COMPANION CARE
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 702 STEVENS RD
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City | BUTLER
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State | AL
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Zip | 36904-2151
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Country | US
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Telephone | 205-604-9184
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Fax |
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Provider Business Mailing Address
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Address Line | 3370 HWY 156
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City | PENNINGTON
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State | AL
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Zip | 36916
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Country | US
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Telephone | 205-604-9184
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | LAWANDA PRESTAGE
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Credential | R.N.
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Telephone | 205-604-9184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 1-084006
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License Number State | AL
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