=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205320538
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMERON HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2018
-----------------------------------------------------
Last Update Date | 06/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8324 CAMERON ROAD
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-773-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 920 RIDGEBROOK RD
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21152-9390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-773-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | MELANIE HENRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-773-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------