Provider Demographics
NPI:1811205370
Name:CBL MEDICAL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:CBL MEDICAL ENTERPRISES, INC.
Other - Org Name:ADVANTAGE PLUS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-559-9480
Mailing Address - Street 1:2719 WESTWARD DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-1229
Mailing Address - Country:US
Mailing Address - Phone:936-559-9480
Mailing Address - Fax:936-559-9498
Practice Address - Street 1:2719 WESTWARD DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-1229
Practice Address - Country:US
Practice Address - Phone:936-559-9480
Practice Address - Fax:936-559-9498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013780251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-7683Medicare PIN