Provider Demographics
NPI:1073943908
Name:CCD HOME CARE SERVICES
Entity Type:Organization
Organization Name:CCD HOME CARE SERVICES
Other - Org Name:LISA MCGOWAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-556-6960
Mailing Address - Street 1:86 MADRID CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5623
Mailing Address - Country:US
Mailing Address - Phone:865-556-6960
Mailing Address - Fax:
Practice Address - Street 1:86 MADRID CT
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5623
Practice Address - Country:US
Practice Address - Phone:865-556-6960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care