Provider Demographics
NPI:1548876592
Name:CHRYSOLITE PRECIOUS HOMECARE
Entity type:Organization
Organization Name:CHRYSOLITE PRECIOUS HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTELLE
Authorized Official - Middle Name:WADINE
Authorized Official - Last Name:KAMANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-543-9344
Mailing Address - Street 1:3556 VELA LN APT 5209
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2276
Mailing Address - Country:US
Mailing Address - Phone:214-233-5633
Mailing Address - Fax:
Practice Address - Street 1:3556 VELA LN APT 5209
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2276
Practice Address - Country:US
Practice Address - Phone:214-233-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care