MEDICARE: CONSULIS HEALTH GROUP, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	261QC1500X	Community Health Clinic/Center
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1598284812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSULIS HEALTH GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 155502
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76155-0502
Country	:	US
Telephone Number	:	817-507-3555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1164 COUNTRY CLUB LN STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-2496
Country	:	US
Telephone Number	:	817-507-3555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AKOA DONAHUE
Credential	:
Telephone Number	:	817-507-3555

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	09/19/2017

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