Provider Demographics
NPI:1659583441
Name:CHARTWELL COMMUNITY SERVICE, INC
Entity Type:Organization
Organization Name:CHARTWELL COMMUNITY SERVICE, INC
Other - Org Name:JORDAN HEALTH SERVICE, A PART OF THE ELARA CARING NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF REGULATORY
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-234-1866
Mailing Address - Street 1:714 WEST GIPSON
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:77506-4960
Mailing Address - Country:US
Mailing Address - Phone:409-384-6577
Mailing Address - Fax:409-384-6569
Practice Address - Street 1:714 WEST GIPSON
Practice Address - Street 2:SUITE 10
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:77506-4960
Practice Address - Country:US
Practice Address - Phone:409-384-6577
Practice Address - Fax:409-384-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011269251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032808JASOtherAAA
TX23380695OtherAPS
TX=========JASOtherVA