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General NPI Number Information
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NPI Number | 1164913752
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Entity Type | Individual
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Provider Name | CHELSEA LAJUAN WHITEHEAD
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Gender | Female
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Dates
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Enumeration Date | 05/20/2018
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Last Update Date | 05/20/2018
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Provider Practice Location Address
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Address Line | 237 HALLBROOK DR
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City | FORT WORTH
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State | TX
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Zip | 76134-3931
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Country | US
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Telephone | 817-806-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 237 HALLBROOK DR
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City | FORT WORTH
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State | TX
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Zip | 76134-3931
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Country | US
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Telephone | 817-806-6090
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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