MEDICARE: CHAVELLE C HENLEY

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1891318143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAVELLE C HENLEY

Provider Business Mailing Address
First Line	:	7710 W INTERSTATE 10
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-4711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5127 VILLAGE CRST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3812
Country	:	US
Telephone Number	:	210-849-4687
Fax Number	:

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

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	05/22/2020

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Directions to “ CHAVELLE C HENLEY ” Practice Location

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