MEDICARE: CHAPA RESIDENTIAL CARE HOME

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	000578	TX

General Provider Information

NPI Number	:	1225047939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAPA RESIDENTIAL CARE HOME

Provider Business Mailing Address
First Line	:	216 W COUNTY ROAD 5719
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-4028
Country	:	US
Telephone Number	:	830-709-4420
Fax Number	:	830-709-5038

Provider Business Practice Location Address
First Line	:	216 W COUNTY ROAD 5719
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-4028
Country	:	US
Telephone Number	:	830-709-4420
Fax Number	:	830-709-5038

Authorized Official
Title or Position	:	OWNER/ ADMINISTRATOR
Name	:	MRS. ANGEL DUNCAN CHAPA
Credential	:
Telephone Number	:	830-665-5294

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/22/2020

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Directions to “CHAPA RESIDENTIAL CARE HOME ” Practice Location

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