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NPI Code Detail

MEDICARE: 4C2W, LLC

MEDICARE: 4C2W, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency012503TX

General Provider Information

NPI Number : 1346570769
Entity Type Code : Organization
Provider Name (Legal Business Name) : 4C2W, LLC
Provider Business Mailing Address
First Line : 8207 HUDSON AVE
Second Line : SUITE C
City : LUBBOCK
State : TX
Zip : 79423-2805
Country : US
Telephone Number : 806-687-7800
Fax Number : 806-745-4559
Provider Business Practice Location Address
First Line : 3133 EXECUTIVE DR
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-6801
Country : US
Telephone Number : 325-949-0700
Fax Number : 325-949-0778
Authorized Official
Title or Position : ADMINISTRATOR/OWNER
Name : FELISA CARSON
Credential : RN
Telephone Number : 806-687-7800
Provider Enumeration Date : 01/07/2010
Last Update Date : 01/07/2010

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