1427289065 NPI number — CHINNAM GROUP INC

Table of content: (NPI 1427289065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427289065 NPI number — CHINNAM GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHINNAM GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROVIDENCE HEALTHCARE SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427289065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 S INDUSTRIAL BLVD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EULESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76040-5072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-545-3538
Provider Business Mailing Address Fax Number:
817-358-3906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 S INDUSTRIAL BLVD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EULESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76040-5072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-545-3538
Provider Business Practice Location Address Fax Number:
817-358-3906
Provider Enumeration Date:
07/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IBEH
Authorized Official First Name:
JOSEPHINE
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-545-3538

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 013198 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".