Provider Demographics
NPI:1407562598
Name:HEALTH COMPANION LLC
Entity Type:Organization
Organization Name:HEALTH COMPANION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:
Authorized Official - Last Name:KWIZERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-240-0171
Mailing Address - Street 1:6309 ARMADILLO CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3192
Mailing Address - Country:US
Mailing Address - Phone:682-240-0171
Mailing Address - Fax:
Practice Address - Street 1:271 E HOME IMPROVEMENT WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5475
Practice Address - Country:US
Practice Address - Phone:682-240-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children