1568566099 NPI number — CHARTWELL COMMUNITY SERVICES, INC.

Table of content: (NPI 1568566099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568566099 NPI number — CHARTWELL COMMUNITY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARTWELL COMMUNITY SERVICES, 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:
Provider Other Organization Name Type Code:
6
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:
1568566099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3010 LYNDON B JOHNSON FWY STE 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-234-1866
Provider Business Mailing Address Fax Number:
903-537-8420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 S WHEELER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75951-4544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-384-6577
Provider Business Practice Location Address Fax Number:
409-242-6634
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONASTIERE
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPLIANCE PRIVACY&SAFETY OFFICER
Authorized Official Telephone Number:
517-768-4373

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  011269 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 945642165 . This is a "ANSI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001001533 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 945533160 . This is a "TDH CONNECT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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