MEDICARE: CHRISCILLIA PEDIATRIC CARE INCORPORATED

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1235565458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISCILLIA PEDIATRIC CARE INCORPORATED

Provider Business Mailing Address
First Line	:	6006 BELLAIRE BLVD
Second Line	:	STE 218
City	:	HOUSTON
State	:	TX
Zip	:	77081-5404
Country	:	US
Telephone Number	:	713-664-1673
Fax Number	:	713-664-1674

Provider Business Practice Location Address
First Line	:	6006 BELLAIRE BLVD
Second Line	:	STE 216
City	:	HOUSTON
State	:	TX
Zip	:	77081-5404
Country	:	US
Telephone Number	:	713-664-1673
Fax Number	:	713-664-1674

Authorized Official
Title or Position	:	ADIMINISTRATOR
Name	:	CHRISTOPHER MADUEKE
Credential	:
Telephone Number	:	713-664-1673

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	10/01/2013

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