Provider Demographics
NPI:1477556827
Name:CHAMBERS HOME HEALTH AGENCY OF NORTHEAST TEXAS COMPANY
Entity Type:Organization
Organization Name:CHAMBERS HOME HEALTH AGENCY OF NORTHEAST TEXAS COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-572-9700
Mailing Address - Street 1:201 W 20TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2325
Mailing Address - Country:US
Mailing Address - Phone:903-572-9700
Mailing Address - Fax:903-572-2447
Practice Address - Street 1:201 W 20TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2325
Practice Address - Country:US
Practice Address - Phone:903-572-9700
Practice Address - Fax:903-572-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679171251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157361001Medicaid
TX679171Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER