Provider Demographics
NPI:1063765915
Name:CHETRUM CORPORATION
Entity type:Organization
Organization Name:CHETRUM CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLAYINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINFESOYE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-352-9335
Mailing Address - Street 1:4414 CENTERVIEW
Mailing Address - Street 2:STE 275
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1418
Mailing Address - Country:US
Mailing Address - Phone:210-255-1083
Mailing Address - Fax:210-255-1335
Practice Address - Street 1:4414 CENTERVIEW
Practice Address - Street 2:STE 275
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1418
Practice Address - Country:US
Practice Address - Phone:210-255-1083
Practice Address - Fax:210-255-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251J00000X, 310400000X, 315D00000X, 322D00000X, 332B00000X, 347C00000X, 385H00000X
TX015635251F00000X, 251G00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care