Provider Demographics
NPI:1962711879
Name:CCFR, LLC
Entity type:Organization
Organization Name:CCFR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:ATTORNEY-AT-LAW
Authorized Official - Phone:337-739-3483
Mailing Address - Street 1:1001 W PINHOOK RD
Mailing Address - Street 2:BUILDING #3, SUITE 105B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2448
Mailing Address - Country:US
Mailing Address - Phone:877-449-5089
Mailing Address - Fax:877-631-5351
Practice Address - Street 1:1001 W PINHOOK RD
Practice Address - Street 2:BUILDING #3, SUITE 105B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2448
Practice Address - Country:US
Practice Address - Phone:877-449-5089
Practice Address - Fax:877-335-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6494780001Medicare NSC