Provider Demographics
NPI:1164859583
Name:MUSTARD SEED COMPANION CARE
Entity Type:Organization
Organization Name:MUSTARD SEED COMPANION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:205-604-9184
Mailing Address - Street 1:3370 HWY 156
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:36916
Mailing Address - Country:US
Mailing Address - Phone:205-604-9184
Mailing Address - Fax:
Practice Address - Street 1:702 STEVENS RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2151
Practice Address - Country:US
Practice Address - Phone:205-604-9184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084006253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care