Organization
COUNTRY ROAD RESOURCES, INC.
Active
Organization
COUNTRY ROAD RESOURCES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOHNIECE WHITEHEAD (DIRECTOR)
(318) 847-4193
Entity
Organization
Contact information
Practice address
25687 HWY 371, SAREPTA, LA 71071
(318) 847-4193
(318) 847-4192
Mailing address
PO BOX 93, SAREPTA, LA 71071-0093
(318) 847-4193
(318) 847-4192
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
PCA 11002
LA
3747P1801X
Personal Care Attendant
Primary
RC 11001
LA
3747P1801X
Personal Care Attendant
SIL 11000
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1463299
—
LA
Enumeration date
04/03/2007
Last updated
08/22/2020
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