Provider Demographics
NPI:1306354550
Name:CCS COMPLETE CARE SOLUTIONS LLC
Entity type:Organization
Organization Name:CCS COMPLETE CARE SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARISSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:832-414-4522
Mailing Address - Street 1:17432 S FM 225
Mailing Address - Street 2:
Mailing Address - City:DOUGLASS
Mailing Address - State:TX
Mailing Address - Zip Code:75943-4206
Mailing Address - Country:US
Mailing Address - Phone:832-414-4522
Mailing Address - Fax:
Practice Address - Street 1:7084 W STATE HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-4704
Practice Address - Country:US
Practice Address - Phone:832-414-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312673164X00000X
172A00000X, 374T00000X, 374U00000X
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing PersonnelGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty