Provider Demographics
NPI:1356517932
Name:CRT PERSONAL CARE ASSISTING SERVICE
Entity type:Organization
Organization Name:CRT PERSONAL CARE ASSISTING SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:04/16/2008
Authorized Official - Phone:214-280-6369
Mailing Address - Street 1:13223 FISH RD # 175
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75253-3153
Mailing Address - Country:US
Mailing Address - Phone:214-280-6369
Mailing Address - Fax:
Practice Address - Street 1:500 N HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4964
Practice Address - Country:US
Practice Address - Phone:214-280-6369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008538398251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health