Provider Demographics
NPI:1376085977
Name:OTTRISS COMPLETE CARE LLC
Entity Type:Organization
Organization Name:OTTRISS COMPLETE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OTTRISS
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-238-8559
Mailing Address - Street 1:3700 N EDWARDS ST APT 1313
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2729
Mailing Address - Country:US
Mailing Address - Phone:432-238-8559
Mailing Address - Fax:
Practice Address - Street 1:3700 N EDWARDS ST APT 1313
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-2729
Practice Address - Country:US
Practice Address - Phone:432-238-8559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695305251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care