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NPI Code Detail

MEDICARE: SOLA SENIOR CARE

MEDICARE: SOLA SENIOR CARE
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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1538599394
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOLA SENIOR CARE
Provider Business Mailing Address
First Line : 4500 MERCANTILE PLAZA DR STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-4206
Country : US
Telephone Number : 817-755-8787
Fax Number :
Provider Business Practice Location Address
First Line : 4500 MERCANTILE PLAZA DR STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-4206
Country : US
Telephone Number : 817-755-8787
Fax Number :
Authorized Official
Title or Position : PRESIDENT, OWNER
Name : JASON LOGAN
Credential :
Telephone Number : 817-755-8787
Provider Enumeration Date : 11/14/2013
Last Update Date : 03/08/2016

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Directions to “SOLA SENIOR CARE ” Practice Location

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