Provider Demographics
NPI:1710675475
Name:CIVIL ASSIST PATIENT CARE SERVICES
Entity Type:Organization
Organization Name:CIVIL ASSIST PATIENT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-684-6020
Mailing Address - Street 1:1067 JOHNSON LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-5523
Mailing Address - Country:US
Mailing Address - Phone:312-684-6020
Mailing Address - Fax:
Practice Address - Street 1:105 WALNUT ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-4240
Practice Address - Country:US
Practice Address - Phone:312-684-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No347E00000XTransportation ServicesTransportation Broker