Provider Demographics
NPI:1902980709
Name:SIERCAM HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:SIERCAM HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLZ
Authorized Official - Middle Name:TATAW
Authorized Official - Last Name:BISONG
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:281-232-9990
Mailing Address - Street 1:812 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2508
Mailing Address - Country:US
Mailing Address - Phone:281-232-9990
Mailing Address - Fax:281-232-9994
Practice Address - Street 1:812 3RD ST
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2508
Practice Address - Country:US
Practice Address - Phone:281-232-9990
Practice Address - Fax:281-232-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010105251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182728901Medicaid
TX679574Medicare ID - Type Unspecified