Provider Demographics
NPI:1003308016
Name:ROCQUEMORE, CHASITY
Entity Type:Individual
Prefix:MS
First Name:CHASITY
Middle Name:
Last Name:ROCQUEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10839 SCOTCH ROSE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8651
Mailing Address - Country:US
Mailing Address - Phone:443-931-9919
Mailing Address - Fax:
Practice Address - Street 1:10839 SCOTCH ROSE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-8651
Practice Address - Country:US
Practice Address - Phone:443-931-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251300000XAgenciesLocal Education Agency (LEA)
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist