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General NPI Number Information
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NPI Number | 1902980709
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Entity Type | Organization
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Legal Business Name | SIERCAM HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 812 3RD ST
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City | ROSENBERG
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State | TX
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Zip | 77471-2508
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Country | US
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Telephone | 281-232-9990
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Fax | 281-232-9994
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Provider Business Mailing Address
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Address Line | 812 3RD ST
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City | ROSENBERG
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State | TX
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Zip | 77471-2508
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Country | US
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Telephone | 281-232-9990
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Fax | 281-232-9994
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CHARLZ TATAW BISONG SR.
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Credential |
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Telephone | 281-232-9990
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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 | 010105
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License Number State | TX
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