NPIMap

Organization Active NPI

Country Road Resources, Inc

  • Personal Care Attendant
  • Sarepta, LA
National Provider Identifier
1073636015
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Personal Care AttendantTaxonomy code 3747P1801X
License
1463272 Issued in LA
Legal business name
COUNTRY ROAD RESOURCES, INC
Practice address
25687 Hwy 371
Sarepta, LA 71071
Phone
(318) 847-4193
Fax
(318) 847-4192
NPI assigned
Apr 6, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Johniece Whitehead
Title
Director
Phone
(318) 847-4193

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Care Attendant 3747P1801X 1463272 LA Primary

Addresses

Primary practice location

25687 Hwy 371
Sarepta, LA 71071

Mailing address

PO Box 93
Sarepta, LA 71071-0093
Phone (318) 847-4193

Other identifiers 1

IdentifierTypeStateIssuer
1463272MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Country Road Resources Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073636015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 93",
            "city": "SAREPTA",
            "state": "LA",
            "postal_code": "710710093",
            "telephone_number": "318-847-4193",
            "fax_number": "318-847-4192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25687 HWY 371",
            "city": "SAREPTA",
            "state": "LA",
            "postal_code": "71071",
            "telephone_number": "318-847-4193",
            "fax_number": "318-847-4192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY ROAD RESOURCES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHITEHEAD",
        "authorized_official_first_name": "JOHNIECE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "318-847-4193",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "LA",
            "license": "1463272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1463272",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sarepta, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.