=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376655001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST CHARLES MEDICAL SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 10/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4143 BLUEBONNET DR
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-3909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-234-7233
-----------------------------------------------------
Fax | 832-532-3697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4143 BLUEBONNET DR
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-3909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-234-7233
-----------------------------------------------------
Fax | 832-532-3697
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN,DON
-----------------------------------------------------
Name | NONYE OZONOH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-234-7233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------