MEDICARE: CELESTIAL HEALING HOME HEALTH CARE, 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	012170	TX

General Provider Information

NPI Number	:	1740222058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELESTIAL HEALING HOME HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	3702 N GLASSCOCK RD
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78573-8462
Country	:	US
Telephone Number	:	956-581-4411
Fax Number	:	956-581-4979

Provider Business Practice Location Address
First Line	:	3702 N GLASSCOCK RD
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78573-8462
Country	:	US
Telephone Number	:	956-581-4411
Fax Number	:	956-581-4979

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. EDITH CAVAZOS
Credential	:	NONE
Telephone Number	:	956-581-4411

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	10/29/2008

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