MEDICARE: CLEO HEALTHCARE SERVICES 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	3336C0003X	Community/Retail Pharmacy	26415	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4543864	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1699814962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEO HEALTHCARE SERVICES INC.

Provider Business Mailing Address
First Line	:	13415 WOODFOREST BLVD
Second Line	:	STE F
City	:	HOUSTON
State	:	TX
Zip	:	77015-2922
Country	:	US
Telephone Number	:	713-330-4400
Fax Number	:	713-330-4405

Provider Business Practice Location Address
First Line	:	13415 WOODFOREST BLVD
Second Line	:	STE F
City	:	HOUSTON
State	:	TX
Zip	:	77015-2922
Country	:	US
Telephone Number	:	713-330-4400
Fax Number	:	713-330-4405

Authorized Official
Title or Position	:	OWNER
Name	:	DELORIS THOMPSON
Credential	:
Telephone Number	:	713-330-4400

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	02/26/2013

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