Provider Demographics
NPI:1760767354
Name:MELANCON CAPITAL INVESTMENTS LLC
Entity Type:Organization
Organization Name:MELANCON CAPITAL INVESTMENTS LLC
Other - Org Name:BREATH OF LIFE HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-965-6057
Mailing Address - Street 1:1081 GABLES DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8589
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:287 HWY 403
Practice Address - Street 2:
Practice Address - City:PAINCOURTVILLE
Practice Address - State:LA
Practice Address - Zip Code:70391
Practice Address - Country:US
Practice Address - Phone:972-965-6057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health