Provider Demographics
NPI:1447632302
Name:LIVING COUNTRY HOME CARE SERVICES, INC
Entity type:Organization
Organization Name:LIVING COUNTRY HOME CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:432-238-0378
Mailing Address - Street 1:30 VILLAGE CIR STE B
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6345
Mailing Address - Country:US
Mailing Address - Phone:432-686-1977
Mailing Address - Fax:432-686-1978
Practice Address - Street 1:2753 SE 4001
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-5958
Practice Address - Country:US
Practice Address - Phone:432-238-0378
Practice Address - Fax:432-203-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health