| Organization Name: | CRIMSON OAK PERSONAL CARE LLC |
| NPI Number: | 1710246095 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY JONES (OWNER) |
| Mailing Address: | 3519 Patrick St Suite151 Lake Charles |
| State: | LA US |
| Postal Code: | 706051748 |
| Phone Number: | 3374780497 |
| Fax Number: | 3374780498 |
| NPI Enumeration Date: | 05/08/2012 |
| NPI Last Update Date: | 05/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | 2203781054 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |