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
253Z00000X
In Home Supportive Care Agency
—
—
3747P1801X
Personal Care Attendant
Primary
1461041
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1461041
—
LA
Enumeration date
04/17/2007
Last updated
06/21/2022
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