Provider Demographics
NPI:1821226564
Name:ESTELLE CHAMBLIN-MOUSSIGNAC
Entity Type:Organization
Organization Name:ESTELLE CHAMBLIN-MOUSSIGNAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE DUTY NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBLIN-MOUSSIGNAC
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:517-562-6090
Mailing Address - Street 1:15 ANTWERP ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1301
Mailing Address - Country:US
Mailing Address - Phone:617-562-6090
Mailing Address - Fax:
Practice Address - Street 1:15 ANTWERP ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1301
Practice Address - Country:US
Practice Address - Phone:617-562-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2610623140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========9Medicaid