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General NPI Number Information
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NPI Number | 1306354550
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Entity Type | Organization
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Legal Business Name | CCS COMPLETE CARE SOLUTIONS LLC
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 01/22/2018
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Provider Practice Location Address
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Address Line | 7084 W STATE HIGHWAY 21
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City | NACOGDOCHES
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State | TX
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Zip | 75964-4704
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Country | US
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Telephone | 832-414-4522
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Fax |
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Provider Business Mailing Address
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Address Line | 17432 S FM 225
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City | DOUGLASS
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State | TX
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Zip | 75943-4206
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Country | US
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Telephone | 832-414-4522
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/ADMINISTRATOR
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Name | MRS. KARISSA K. RICKMAN
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Credential | LVN
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Telephone | 832-414-4522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 312673
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374T00000X
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Taxonomy Name | Religious Nonmedical Nursing Personnel
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | TX
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