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General NPI Number Information
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NPI Number | 1508083858
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE HEALTH AGENCY, INC.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 1600 E PIONEER PKWY SUITE 343
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City | ARLINGTON
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State | TX
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Zip | 76010-6542
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Country | US
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Telephone | 972-266-8511
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Fax | 972-266-8522
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Provider Business Mailing Address
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Address Line | 1600 E PIONEER PKWY SUITE 343
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City | ARLINGTON
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State | TX
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Zip | 76010-6542
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Country | US
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Telephone | 972-266-8511
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Fax | 972-266-8522
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Authorized Official
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Title or Position | ADMINISTRATOR/DON
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Name | MRS. EVALYNE C SUDOI
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Credential | RN BSN MBA
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Telephone | 972-522-8180
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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 | 014813
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License Number State | TX
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