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Organization

C & R QUALITY LIVING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ROOSEVELT GAYLAH (PRESIDENT)
(701) 235-5744
Entity
Organization

Contact information

Practice address
1336 25TH AVE S STE 213, FARGO, ND 58103-5202
(701) 235-5744
(701) 235-5569
Mailing address
1336 25TH AVE S STE 213, FARGO, ND 58103-5202
(701) 235-5744
(701) 235-5569

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
10067100
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39354
ND
Enumeration date
04/02/2010
Last updated
04/02/2010
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