Provider Demographics
NPI:1104456797
Name:CHARSONY MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:CHARSONY MEDICAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:
Authorized Official - First Name:UGONMA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-760-8414
Mailing Address - Street 1:1019 LARKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4606
Mailing Address - Country:US
Mailing Address - Phone:281-760-8414
Mailing Address - Fax:832-847-4220
Practice Address - Street 1:1019 LARKFIELD DR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-4606
Practice Address - Country:US
Practice Address - Phone:281-760-8414
Practice Address - Fax:832-847-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181087101Medicaid