Organization
A FIRST NAME BASIS HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAKE FACKRELL (CEO)
(337) 233-4778
Entity
Organization
Contact information
Practice address
803 W BAYOU PINES DR, SUITE C, LAKE CHARLES, LA 70601-7096
(337) 990-0300
Mailing address
803 W BAYOU PINES DR, SUITE C, LAKE CHARLES, LA 70601-7096
(337) 990-0300
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
2203782459
LA
Other
Enumeration date
10/28/2015
Last updated
10/28/2015
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