MEDICARE: SILVERTRAIL OMPASSION CAE.LLC

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	016187	TX

General Provider Information

NPI Number	:	1578943312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVERTRAIL OMPASSION CAE.LLC

Provider Business Mailing Address
First Line	:	PO BOX 540574
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-0574
Country	:	US
Telephone Number	:	817-633-0383
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 HEATHER BROOK LN APT 804
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-5177
Country	:	US
Telephone Number	:	817-633-0383
Fax Number	:	817-633-0084

Authorized Official
Title or Position	:	OWNER
Name	:	MS. GRADA BERRY
Credential	:
Telephone Number	:	682-217-5822

Provider Enumeration Date	:	06/07/2015
Last Update Date	:	06/07/2015

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