Provider Demographics
NPI:1083293542
Name:CAMISSA HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:CAMISSA HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCOISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAMBO FOMUNUNG
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:469-655-0038
Mailing Address - Street 1:2801 LAKE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-6401
Mailing Address - Country:US
Mailing Address - Phone:469-655-0038
Mailing Address - Fax:972-463-0414
Practice Address - Street 1:2801 LAKE VISTA DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-6401
Practice Address - Country:US
Practice Address - Phone:469-655-0038
Practice Address - Fax:972-463-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty