Provider Demographics
NPI:1689879785
Name:CHARISMATA HOME HEALTH, LLC
Entity Type:Organization
Organization Name:CHARISMATA HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, SUP. NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:YQUADEA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-907-6700
Mailing Address - Street 1:13325 HARGRAVE RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4539
Mailing Address - Country:US
Mailing Address - Phone:281-907-6700
Mailing Address - Fax:281-907-0964
Practice Address - Street 1:13325 HARGRAVE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4539
Practice Address - Country:US
Practice Address - Phone:281-907-6700
Practice Address - Fax:281-907-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011630251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212103001Medicaid
TX212103001Medicaid