Provider Demographics
NPI:1730519851
Name:STETSON, CHARMAINE MICHELLE (OWNER)
Entity type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:MICHELLE
Last Name:STETSON
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:MRS
Other - First Name:CHARMAINE
Other - Middle Name:MICHELLE
Other - Last Name:MOODLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 ANGEL HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2283
Mailing Address - Country:US
Mailing Address - Phone:729-161-9309
Mailing Address - Fax:972-584-1708
Practice Address - Street 1:103 ANGEL HOLLOW LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-2283
Practice Address - Country:US
Practice Address - Phone:972-916-1930
Practice Address - Fax:972-584-1708
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility