=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366654246
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARTWELL COMMUNITY SERVICE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 07/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4444 CORONA DR SUITE 233
-----------------------------------------------------
City | CORPUS CHRISTI
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-855-2090
-----------------------------------------------------
Fax | 361-855-2090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3010 LYNDON B JOHNSON FWY STE 1100
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-768-4373
-----------------------------------------------------
Fax | 903-537-8420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMPLIANCE AND PRIVACY OFFICER
-----------------------------------------------------
Name | KATIE MONASTIERE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 517-768-4373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 011265
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 011272
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 011264
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------