=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477556827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHAMBERS HOME HEALTH AGENCY OF NORTHEAST TEXAS COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2005
-----------------------------------------------------
Last Update Date | 03/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 W 20TH ST STE 102
-----------------------------------------------------
City | MT PLEASANT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75455-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-572-9700
-----------------------------------------------------
Fax | 903-572-2447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 W 20TH ST STE 102
-----------------------------------------------------
City | MT PLEASANT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75455-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-572-9700
-----------------------------------------------------
Fax | 903-572-2447
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | MELISSA CHAMBERS
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 903-572-9700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 679171
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------