=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699701201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILEX HOME CARE SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2006
-----------------------------------------------------
Last Update Date | 09/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 HAMPSHIRE LN
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-6596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-772-2940
-----------------------------------------------------
Fax | 972-772-2940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 127 HAMPSHIRE LN
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-6596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-772-2940
-----------------------------------------------------
Fax | 972-772-2940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DON- ADMINISTRATOR
-----------------------------------------------------
Name | MS. HAPPINESS NWABUKO
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 972-772-2940
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 009532
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------