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General NPI Number Information
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NPI Number | 1710246095
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Entity Type | Organization
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Legal Business Name | CRIMSON OAK PERSONAL CARE LLC
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 3519 PATRICK ST SUITE151
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City | LAKE CHARLES
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State | LA
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Zip | 70605-1748
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Country | US
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Telephone | 337-478-0497
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Fax | 337-478-0498
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Provider Business Mailing Address
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Address Line | 419 HIGHWAY 384
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City | LAKE CHARLES
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State | LA
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Zip | 70607-8931
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Country | US
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Telephone | 337-478-0497
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JERRY JONES
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Credential |
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Telephone | 337-478-0497
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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 | 2203781054
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License Number State | LA
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