MEDICARE: CHARMAGNE JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1205267804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARMAGNE JONES

Provider Business Mailing Address
First Line	:	4800 KELLER SPRINGS RD APT 1369
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-6530
Country	:	US
Telephone Number	:	952-220-1369
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 KELLER SPRINGS RD APT 1369
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-6530
Country	:	US
Telephone Number	:	952-220-1369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	12/06/2013

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Directions to “ CHARMAGNE JONES ” Practice Location

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