MEDICARE: CHARON HENDERSON

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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1689341935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARON HENDERSON

Provider Business Mailing Address
First Line	:	9512 GLENDALE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-1603
Country	:	US
Telephone Number	:	800-515-4201
Fax Number	:

Provider Business Practice Location Address
First Line	:	9512 GLENDALE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-1603
Country	:	US
Telephone Number	:	800-515-4201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	08/25/2021

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Directions to “ CHARON HENDERSON ” Practice Location

Language	Start Address	Practice Location

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