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General NPI Number Information
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NPI Number | 1548876592
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Entity Type | Organization
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Legal Business Name | CHRYSOLITE PRECIOUS HOMECARE
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 3556 VELA LN APT 5209
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City | FORT WORTH
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State | TX
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Zip | 76137-2276
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Country | US
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Telephone | 214-233-5633
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Fax |
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Provider Business Mailing Address
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Address Line | 3556 VELA LN APT 5209
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City | FORT WORTH
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State | TX
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Zip | 76137-2276
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Country | US
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Telephone | 214-233-5633
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Fax |
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Authorized Official
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Title or Position | MEDICAL ASSISTANT
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Name | MRS. CHRISTELLE WADINE KAMANDA
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Credential |
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Telephone | 405-543-9344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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