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General NPI Number Information
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NPI Number | 1932404563
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Entity Type | Organization
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Legal Business Name | ANTHEM SENIOR CARE SERVICES, LLC
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 604 MOORE AVE
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City | PORTLAND
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State | TX
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Zip | 78374-1608
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Country | US
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Telephone | 361-643-2323
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Fax | 361-643-1212
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Provider Business Mailing Address
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Address Line | 604 MOORE AVE
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City | PORTLAND
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State | TX
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Zip | 78374-1608
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Country | US
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Telephone | 361-643-2323
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CFO
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Name | MR. CHRISTOPHER J GUILIANELLE
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Credential |
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Telephone | 361-643-2323
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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 | PENDING
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License Number State | TX
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