Provider Demographics
NPI:1790175578
Name:KILLCREASE HOME CARE
Entity Type:Organization
Organization Name:KILLCREASE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN-KILLCREASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-608-8088
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-0243
Mailing Address - Country:US
Mailing Address - Phone:318-608-8088
Mailing Address - Fax:
Practice Address - Street 1:11239 HIGHWAY 143
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-5535
Practice Address - Country:US
Practice Address - Phone:318-608-8088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home