MEDICARE: CHARIS HEALTHCARE SOLUTIONS LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1477235893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARIS HEALTHCARE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	11937 SUMMERWIND DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7598
Country	:	US
Telephone Number	:	682-558-4850
Fax Number	:

Provider Business Practice Location Address
First Line	:	11937 SUMMERWIND DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7598
Country	:	US
Telephone Number	:	682-558-4850
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NOSAKHARE OMOSEDEH ADU
Credential	:	NURSE PRACTIONER
Telephone Number	:	682-558-4850

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	08/04/2023

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