Provider Demographics
NPI:1467904524
Name:4C2W, LLC
Entity Type:Organization
Organization Name:4C2W, LLC
Other - Org Name:COMFORT KEEPERS #767
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CCM
Authorized Official - Phone:806-687-7800
Mailing Address - Street 1:3121 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6801
Mailing Address - Country:US
Mailing Address - Phone:325-949-0700
Mailing Address - Fax:325-949-0778
Practice Address - Street 1:2517 74TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1405
Practice Address - Country:US
Practice Address - Phone:806-687-7800
Practice Address - Fax:806-745-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012503253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care