=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184648537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIAP HEALTH & REHAB SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 11/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11410 MARTIN LUTHER KING JR. BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77271-0934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-541-6520
-----------------------------------------------------
Fax | 713-541-6521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 710934
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77271-0934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-541-6520
-----------------------------------------------------
Fax | 713-541-6521
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. CHARLES CHUKWUNWIKE AZIH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-541-6520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 009817
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------