MEDICARE: CQ HOME HEALTH ACQUISITION HOLDINGS LP

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	009382	TX

General Provider Information

NPI Number	:	1952313819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CQ HOME HEALTH ACQUISITION HOLDINGS LP

Provider Business Mailing Address
First Line	:	PO BOX 1387
Second Line	:	412 HWY 37 SOUTH
City	:	MOUNT VERNON
State	:	TX
Zip	:	75457-1387
Country	:	US
Telephone Number	:	903-537-8629
Fax Number	:	903-537-8440

Provider Business Practice Location Address
First Line	:	1101 BROOK AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5008
Country	:	US
Telephone Number	:	940-761-6191
Fax Number	:	940-761-6194

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. CARLA HERRERA
Credential	:
Telephone Number	:	903-537-8629

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	05/24/2016

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