Provider Demographics
NPI:1497415442
Name:CENTENARY HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:CENTENARY HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NCHOTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-427-7769
Mailing Address - Street 1:21408 CUPOLA VW
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2654
Mailing Address - Country:US
Mailing Address - Phone:720-427-7769
Mailing Address - Fax:
Practice Address - Street 1:21408 CUPOLA VW
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2654
Practice Address - Country:US
Practice Address - Phone:720-427-7769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health