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General NPI Number Information
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NPI Number | 1396324950
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Entity Type | Organization
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Legal Business Name | COUNTRY CARE COMPANIONS LLC
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 832 WASHINGTON ST
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City | COLUMBUS
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State | TX
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Zip | 78934-2221
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Country | US
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Telephone | 970-623-2449
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2935
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City | GRAND JUNCTION
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State | CO
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Zip | 81502-2935
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Country | US
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Telephone | 970-623-2449
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERESA HENDRYX
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Credential |
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Telephone | 970-623-2449
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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 |
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License Number State |
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