Provider Demographics
NPI: | 1538647052 |
---|---|
Name: | CEC HEALTH AGENCY |
Entity Type: | Organization |
Organization Name: | CEC HEALTH AGENCY |
Other - Org Name: | GATSBY HOME HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CEKEYTRA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CHAMBERS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 682-564-2349 |
Mailing Address - Street 1: | 7105 KICKAPOO DR |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT WORTH |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76179-4710 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 682-564-2349 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7105 KICKAPOO DR |
Practice Address - Street 2: | |
Practice Address - City: | FORT WORTH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76179-4710 |
Practice Address - Country: | US |
Practice Address - Phone: | 682-564-2349 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-08-06 |
Last Update Date: | 2018-08-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | |
No | 174200000X | Other Service Providers | Meals | |
No | 177F00000X | Other Service Providers | Lodging | |
No | 251B00000X | Agencies | Case Management | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
No | 251E00000X | Agencies | Home Health | |
No | 251G00000X | Agencies | Hospice Care, Community Based | |
No | 253Z00000X | Agencies | In Home Supportive Care | |
No | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | |
No | 385H00000X | Respite Care Facility | Respite Care |