MEDICARE: CEIBA GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1770114548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEIBA GROUP INC

Provider Business Mailing Address
First Line	:	300 N AKARD ST APT 1519
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-3458
Country	:	US
Telephone Number	:	210-729-6222
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N AKARD ST APT 1519
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-3458
Country	:	US
Telephone Number	:	210-729-6222
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOWIZZA MEDINA
Credential	:	RN
Telephone Number	:	210-729-6222

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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Directions to “CEIBA GROUP INC ” Practice Location

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