Provider Demographics
NPI:1760532287
Name:C&F CONCRETE ENGRAVERS, INC.
Entity Type:Organization
Organization Name:C&F CONCRETE ENGRAVERS, INC.
Other - Org Name:DESERT NURSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:FEEZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-421-2239
Mailing Address - Street 1:121 W FLORENCE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-4089
Mailing Address - Country:US
Mailing Address - Phone:520-421-2239
Mailing Address - Fax:520-421-2503
Practice Address - Street 1:121 W FLORENCE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4089
Practice Address - Country:US
Practice Address - Phone:520-421-2239
Practice Address - Fax:520-421-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ482597-01Medicaid