Camissa Home Health Agency LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

CAMISSA HOME HEALTH AGENCY LLC

Practice address

2801 Lake Vista Dr
Wylie, TX 75098-6401

Phone

(469) 655-0038

Fax

(972) 463-0414

NPI assigned

Apr 3, 2021

Last updated

Apr 3, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Francoise Wambo Fomunung, CNA

Title

Owner

Phone

(469) 655-0038

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617408000000",
    "number": "1083293542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 LAKE VISTA DR",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750986401",
            "telephone_number": "469-655-0038",
            "fax_number": "972-463-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 LAKE VISTA DR",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750986401",
            "telephone_number": "469-655-0038",
            "fax_number": "972-463-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMISSA HOME HEALTH AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-03",
        "last_updated": "2021-04-03",
        "certification_date": "2021-04-03",
        "status": "A",
        "authorized_official_last_name": "WAMBO FOMUNUNG",
        "authorized_official_first_name": "FRANCOISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-655-0038",
        "authorized_official_credential": "CNA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.