MEDICARE: CHARTWELL COMMUNITY SERVICE, INC

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	011269	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	032808JAS	OTHER	TX	AAA
2	23380695	OTHER	TX	APS

General Provider Information

NPI Number	:	1659583441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARTWELL COMMUNITY SERVICE, INC

Provider Business Mailing Address
First Line	:	714 WEST GIPSON
Second Line	:	SUITE 10
City	:	JASPER
State	:	TX
Zip	:	77506-4960
Country	:	US
Telephone Number	:	409-384-6577
Fax Number	:	409-384-6569

Provider Business Practice Location Address
First Line	:	714 WEST GIPSON
Second Line	:	SUITE 10
City	:	JASPER
State	:	TX
Zip	:	77506-4960
Country	:	US
Telephone Number	:	409-384-6577
Fax Number	:	409-384-6569

Authorized Official
Title or Position	:	VICE PRESIDENT OF REGULATORY
Name	:	DEBRA MILLER
Credential	:
Telephone Number	:	800-234-1866

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	01/04/2019

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Directions to “CHARTWELL COMMUNITY SERVICE, INC ” Practice Location

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