MEDICARE: CHAPPELL HILL PERSONAL ASSISTANT SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1144693813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAPPELL HILL PERSONAL ASSISTANT SERVICES

Provider Business Mailing Address
First Line	:	904 S AUSTIN ST
Second Line	:
City	:	BRENHAM
State	:	TX
Zip	:	77833-4117
Country	:	US
Telephone Number	:	832-298-4563
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 S AUSTIN ST
Second Line	:
City	:	BRENHAM
State	:	TX
Zip	:	77833-4117
Country	:	US
Telephone Number	:	832-298-4563
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RICHARD A EKIBOLAJI
Credential	:
Telephone Number	:	832-298-4563

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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