MEDICARE: CD ROSS HEALTH SYSTEMS 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
1	251G00000X	Community Based Hospice Care Agency		LA
2	251S00000X	Community/Behavioral Health Agency		LA

General Provider Information

NPI Number	:	1710267406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CD ROSS HEALTH SYSTEMS LLC

Provider Business Mailing Address
First Line	:	315 N GOOS BLVD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-2541
Country	:	US
Telephone Number	:	337-214-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 N GOOS BLVD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-2541
Country	:	US
Telephone Number	:	337-214-2030
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARLOS D ROSS
Credential	:	D MIN. PHD
Telephone Number	:	337-214-2030

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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Directions to “CD ROSS HEALTH SYSTEMS LLC ” Practice Location

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