=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992733000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONSOLIDATED HEALTH CARE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2006
-----------------------------------------------------
Last Update Date | 09/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 S KAUFMAN ST
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75966-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-379-2268
-----------------------------------------------------
Fax | 409-379-3183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 812 411 S. KAUFMAN STREET
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75966-0812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-379-2268
-----------------------------------------------------
Fax | 409-379-3183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. GLORIA D JONES
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 409-379-2268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 017473
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------