# A FIRST NAME BASIS HOME CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922470061
- **Authorized official:** JAKE FACKRELL (CEO)
- **Authorized official phone:** (337) 233-4778

## Contact information

- **Practice address:** 803 W BAYOU PINES DR, SUITE C, LAKE CHARLES, LA 70601-7096
- **Practice address phone:** (337) 990-0300
- **Mailing address:** 803 W BAYOU PINES DR, SUITE C, LAKE CHARLES, LA 70601-7096
- **Mailing address phone:** (337) 990-0300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 2203782459 | LA | Yes |

## Other

- **Enumeration date:** 10/28/2015
- **Last updated:** 10/28/2015