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General NPI Number Information
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NPI Number | 1487019436
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Entity Type | Organization
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Legal Business Name | CELEMIAH HOME AND COMMUNITY SUPPORT SERVICE AGENCY
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 17804 BRIDGEFARMER BLVD
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-3484
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Country | US
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Telephone | 512-825-6440
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Fax |
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Provider Business Mailing Address
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Address Line | 17804 BRIDGEFARMER BLVD
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-3484
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RN/ADMINISTRATOR
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Name | JEREMIAH KIPNGETICH CHUMBA
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Credential | RN
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Telephone | 512-825-6440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 833814
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License Number State | TX
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