Provider Demographics
NPI:1972963288
Name:PAT'S HOME-COOKED MEALS
Entity Type:Organization
Organization Name:PAT'S HOME-COOKED MEALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-793-8965
Mailing Address - Street 1:3812 HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:BOYCE
Mailing Address - State:LA
Mailing Address - Zip Code:71409-7905
Mailing Address - Country:US
Mailing Address - Phone:318-793-8965
Mailing Address - Fax:
Practice Address - Street 1:3812 HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:BOYCE
Practice Address - State:LA
Practice Address - Zip Code:71409-7905
Practice Address - Country:US
Practice Address - Phone:318-793-8965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals