Caala Marie Fagan | Blytheville, AR • PECOS Search

Caala Marie Fagan

Case Manager/Care Coordinator

Other Service Providers

1510 Byrum Rd, Blytheville, AR 72315-8033

PECOS Enrollment

Based on the most recent information from CMS, provider Caala Marie Fagan does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1225349913
Provider Type
Individual
Full Name
Fagan, Caala Marie
Credential
ECTD, MHPP

Gender
Female
Sole Proprietor
Yes
Enumeration Date
6/28/2010
Last Updated
6/28/2010

Contact Information

Practice Location

1510 Byrum Rd, Blytheville, AR 72315-8033

Unlisted Fax

Mailing Location

1510 Byrum Rd, Blytheville, AR 72315-8033

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 171M00000X Primary	Description Case Manager/Care Coordinator Other Service Providers	License Unlisted Issuer