=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629922695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTRY ROAD RESOURCES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2026
-----------------------------------------------------
Last Update Date | 02/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25687 US-371
-----------------------------------------------------
City | SAREPTA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-847-4193
-----------------------------------------------------
Fax | 318-847-4192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 93
-----------------------------------------------------
City | SAREPTA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71071-0093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-423-4725
-----------------------------------------------------
Fax | 318-847-4192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JOHNIECE A WHITEHEAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-847-4193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------